Thethi Inderpal, Ramirez Shokufeh, Shen Wei, Zhang Dingding, Mohamad Maha, Kaphle Upendra, Kheir Fayez
Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA.
Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
J Thorac Dis. 2018 Jan;10(1):355-362. doi: 10.21037/jtd.2017.11.134.
Malignant pleural effusion (MPE) develops in approximately 50% of all patients with metastatic cancer. The efficacy of small- large-bore chest tube for pleurodesis in patients with MPE is still not clear.
We performed a meta-analysis to evaluate the efficacy and safety of chest tube size in the management of MPE. A systematic search of Medline (Ovid) and Embase (from 1980 to March 2016) was performed. Randomized clinical trials (RCTs) evaluating the effect of small (≤14 French) large (>14 French) chest tube size on successful pleurodesis for patients with MPE. Of 708 potentially relevant publications, four matched the selection criteria and were included in the meta-analysis.
Overall relative risk (RR) with 95% confidence intervals (CI) was pooled using a random-effects model. Heterogeneity was assessed using Q statistic (significant at P<0.1). In the 231 patients, the success proportion of pleurodesis as well as complication proportion were comparable between large and small chest tube groups with a pooled RR of 0.90 (95% CI, 0.77-1.05; P=0.19; I =17.4%) and 0.95 (95% CI, 0.42-2.15; P=0.90; I =0.9%) respectively. Successful pleurodesis and complication proportion for small large chest tubes were 73.8% 82.0% and 13.0% 10.5%, respectively.
This meta-analysis suggests that small and large chest tubes are both effective treatment for MPE with similar successful pleurodesis and complication proportion. Further RCTs are needed to more clearly determine which size tube is superior.
恶性胸腔积液（MPE）在所有转移性癌症患者中发生率约为50%。小口径与大口径胸管用于MPE患者胸膜固定术的疗效仍不明确。
我们进行了一项荟萃分析，以评估胸管尺寸在MPE治疗中的疗效和安全性。对Medline（Ovid）和Embase（1980年至2016年3月）进行了系统检索。纳入评估小口径（≤14F）与大口径（>14F）胸管尺寸对MPE患者胸膜固定术成功与否影响的随机临床试验（RCT）。在708篇可能相关的出版物中，4篇符合选择标准并纳入荟萃分析。
采用随机效应模型汇总总体相对风险（RR）及95%置信区间（CI）。使用Q统计量评估异质性（P<0.1时有显著性）。在231例患者中，大口径与小口径胸管组胸膜固定术成功率及并发症发生率相当，汇总RR分别为0.90（95%CI，0.77 - 1.05；P = 0.19；I² = 17.4%）和0.95（95%CI，0.42 - 2.15；P = 0.90；I² = 0.9%）。小口径与大口径胸管的胸膜固定术成功率及并发症发生率分别为73.8%与82.0%以及13.0%与10.5%。
该荟萃分析表明，小口径和大口径胸管对MPE均为有效的治疗方法，胸膜固定术成功率及并发症发生率相似。需要进一步的随机对照试验以更明确地确定哪种尺寸的胸管更具优势。
