Zhang Tian-Xiang, Zhang Ye, Liu Zhi-Dong, Zhou Shi-Jie, Xu Shao-Fa
Department of Thoracic Surgery, Beijing Chest Hospital Affiliated with Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
Department of Pharmacology, Beijing Chest Hospital Affiliated with Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
Interact Cardiovasc Thorac Surg. 2018 Nov 1;27(5):695-702. doi: 10.1093/icvts/ivy150.
In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of a volume threshold of 300 ml/day before removing a chest tube (CT) versus 100 ml/day after a lobectomy.
According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of PubMed, Embase, Cochrane Library, Web of Science databases, CNKI, the Wanfang database, CBMdisc and Google Scholar to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software.
Five studies, published between 2014 and 2015, including 615 patients (314 patients who had the CT removed when daily drainage was <300 ml and 301 patients who had the CT removed when daily drainage was <100 ml) met the selection criteria. From the available data, the patients using the volume threshold of 300 ml/day had a significantly decreased duration of drainage [MD = -44.07; 95% confidence interval (CI) -64.45 to -23.68; P < 0.0001] and hospital stay after operation (MD = -2.25; 95% CI -3.52 to -0.97; P = 0.0006) compared with patients using a volume threshold of 100 ml/day after a pulmonary lobectomy. However, no significant differences were observed in postoperative complications, such as pleural fluid reaccumulation [Odds ratio (OR) = 1.73; 95% CI = 0.74-4.07; P = 0.21] and atelectasis (OR = 0.97; 95% CI = 0.52-1.81; P = 0.93). Thoracentesis rates after removing the CT also showed no significant difference (OR = 1.53; 95% CI 0.55-4.22; P = 0.41).
Our results showed that a higher volume threshold, up to 300 ml/day, is effective in reducing hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the volume threshold of 300 ml/day does not increase the occurrence of postoperative atelectasis, pleural fluid reaccumulation and thoracentesis rates. However, this review is limited by the methodological quality of the included trials, and additional studies according to the recommendations of Cochrane Library are appreciated.
在这项荟萃分析中，我们对比较在肺叶切除术后胸管（CT）拔除前每日引流量阈值为300ml/天与100ml/天的疗效的临床研究进行了汇总分析。
根据Cochrane协作网的建议，我们制定了严格的研究方案。我们对PubMed、Embase、Cochrane图书馆、Web of Science数据库、中国知网、万方数据库、中国生物医学文献数据库和谷歌学术进行了系统的电子检索，以确定纳入我们荟萃分析的文章。使用相关关键词进行文献检索。使用RevMan©软件进行荟萃分析。
2014年至2015年发表的5项研究，包括615例患者（314例每日引流量<300ml时拔除CT，301例每日引流量<100ml时拔除CT）符合入选标准。根据现有数据，与肺叶切除术后使用每日引流量阈值100ml/天的患者相比，使用每日引流量阈值300ml/天的患者引流持续时间显著缩短[MD=-44.07；95%置信区间（CI）-64.45至-23.68；P<0.0001]，术后住院时间也显著缩短（MD=-2.25；95%CI-3.52至-0.97；P=0.0006）。然而，在术后并发症方面未观察到显著差异，如胸腔积液再积聚[比值比（OR）=1.73；95%CI=0.74-4.07；P=0.21]和肺不张（OR=0.97；95%CI=0.52-1.81；P=0.93）。拔除CT后的胸腔穿刺率也无显著差异（OR=1.53；95%CI 0.55-4.22；P=0.41）。
我们的结果表明，更高的引流量阈值，高达300ml/天，对于缩短肺叶切除患者的住院时间和引流持续时间是有效的。此外，300ml/天的引流量阈值不会增加术后肺不张、胸腔积液再积聚和胸腔穿刺率的发生。然而，本综述受到纳入试验方法学质量的限制，欢迎根据Cochrane图书馆的建议进行更多研究。
