Zhu Pengzhi, Xia Honggang, Sun Zhongyi, Zhu Deqing, Deng Limin, Zhang Yongmin, Zhang Haiquan, Wang Dongbin
Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China.
Interact Cardiovasc Thorac Surg. 2019 Jun 1;28(6):936-944. doi: 10.1093/icvts/ivy342.
Although primary spontaneous pneumothorax (PSP) is an extremely frequent pathology, there is still no clear consensus on the treatment for these patients. We performed a strict meta-analysis on the effectiveness of manual aspiration (MA) compared to chest tube drainage (CTD) for the treatment of PSP.
A literature search was performed on PubMed, EMBASE and the Cochrane Library to identify randomized controlled trials comparing MA with CTD for the treatment of PSP. Independent reviewers evaluated the methodological quality of the included randomized controlled trials. Statistical heterogeneity among studies was quantitatively evaluated using the I-squared index.
Five randomized controlled trials were included, and a total of 358 subjects were reported on. We found that MA was related to significantly shorter hospital stays [in days; mean difference -1.70, 95% confidence interval (CI) -2.36 to -1.04; P < 0.00001, fixed effect model] compared with CTD. However, no significant differences were found between the 2 treatments for immediate success rate (risk ratio 1.15, 95% CI 0.73-1.81; P = 0.54), 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate. Subgroup analysis showed that MA can provide a significantly lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system.
On the basis of the currently available literature, MA is advantageous in the treatment of PSP because of shorter hospital stays. The subgroup analysis also indicates that MA can provide a lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. However, there are no significant differences between the 2 interventions with respect to immediate success rate, 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate.
虽然原发性自发性气胸（PSP）是一种极为常见的病症，但对于这些患者的治疗仍未达成明确的共识。我们针对手法抽气（MA）与胸腔闭式引流（CTD）治疗PSP的有效性进行了一项严格的荟萃分析。
在PubMed、EMBASE和Cochrane图书馆进行文献检索，以确定比较MA与CTD治疗PSP的随机对照试验。独立评审员评估纳入的随机对照试验的方法学质量。使用I²指数对研究间的统计异质性进行定量评估。
纳入了五项随机对照试验，共报道了358名受试者。我们发现，与CTD相比，MA与显著缩短的住院时间相关[以天为单位；平均差值-1.70，95%置信区间（CI）-2.36至-1.04；P＜0.00001，固定效应模型]。然而，在即时成功率（风险比1.15，95%CI 0.73 - 1.81；P = 0.54）、1年复发率、1周成功率、复发时间、开胸手术率或并发症率方面，两种治疗方法之间未发现显著差异。亚组分析表明，对于管径＞12Fr或采用水封引流系统的情况，MA的住院率显著低于CTD。
基于现有文献，MA在PSP治疗中具有优势，因其住院时间较短。亚组分析还表明，对于管径＞12Fr或采用水封引流系统的情况，MA的住院率低于CTD。然而，在即时成功率、1年复发率、1周成功率、复发时间、开胸手术率或并发症率方面，两种干预措施之间没有显著差异。
