Center for Evidence-Based Medicine, Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Center for Evidence-Based Medicine, Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan.
Chest. 2018 May;153(5):1201-1212. doi: 10.1016/j.chest.2018.01.048. Epub 2018 Feb 13.
The optimal initial treatment approach for pneumothorax remains controversial. This systemic review and meta-analysis investigated the effectiveness of small-bore pigtail catheter (PC) drainage compared with that of large-bore chest tube (LBCT) drainage as the initial treatment approach for all subtypes of pneumothorax.
PubMed and Embase were systematically searched for observational studies and randomized controlled trials published up to October 9, 2017, that compared PC and LBCT as the initial treatment for pneumothorax. The investigative outcomes included success rates, recurrence rates, complication rates, drainage duration, and hospital stay.
Of the 11 included studies (875 patients), the success rate was similar in the PC (79.84%) and LBCT (82.87%) groups, with a risk ratio of 0.99 (95% CI, 0.93 to 1.05; I = 0%). Specifically, PC drainage was associated with a significantly lower complication rate following spontaneous pneumothorax than LBCT drainage (Peto odds ratio: 0.49 [95% CI, 0.28 to 0.85]; I = 29%). In the spontaneous subgroup, PC drainage was associated with a significantly shorter drainage duration (mean difference, -1.51 [95% CI, -2.93 to -0.09]) and hospital stay (mean difference: -2.54 [95% CI, -3.16 to -1.92]; P < .001) than the LBCT group.
Collectively, results of the meta-analysis suggest PC drainage may be considered as the initial treatment option for patients with primary or secondary spontaneous pneumothorax. Ideally, randomized controlled trials are needed to compare PC vs LBCT among different subgroups of patients with pneumothorax, which may ultimately improve clinical care and management for these patients.
PROSPERO; No.: CRD42017078481; URL: https://www.crd.york.ac.uk/prospero/.
气胸的最佳初始治疗方法仍存在争议。本系统评价和荟萃分析调查了小口径猪尾导管（PC）引流与大口径胸腔引流管（LBCT）引流作为所有类型气胸初始治疗方法的效果。
系统检索了截至 2017 年 10 月 9 日发表的比较 PC 和 LBCT 作为气胸初始治疗的观察性研究和随机对照试验，检索数据库包括 PubMed 和 Embase。研究结果包括成功率、复发率、并发症发生率、引流时间和住院时间。
纳入的 11 项研究（875 例患者）中，PC 组（79.84%）和 LBCT 组（82.87%）的成功率相似，风险比为 0.99（95%可信区间，0.93 至 1.05；I²=0%）。具体而言，PC 引流与 LBCT 引流相比，自发性气胸后并发症发生率显著降低（Peto 比值比：0.49[95%可信区间，0.28 至 0.85]；I²=29%）。在自发性亚组中，PC 引流与 LBCT 引流相比，引流时间（平均差值，-1.51[95%可信区间，-2.93 至-0.09]）和住院时间（平均差值：-2.54[95%可信区间，-3.16 至-1.92]）显著缩短（P<0.001）。
总体而言，荟萃分析结果表明，PC 引流可作为原发性或继发性自发性气胸患者的初始治疗选择。理想情况下，需要进行随机对照试验，比较 PC 与 LBCT 在不同类型气胸患者亚组中的疗效，这可能最终改善这些患者的临床治疗和管理。
PROSPERO；编号：CRD42017078481；网址：https://www.crd.york.ac.uk/prospero/。
