MetroHealth Medical Center, Case Western Reserve University School of Medicine (CWRU), USA.
UT Southwestern School of Medicine, USA.
Am J Surg. 2021 May;221(5):873-884. doi: 10.1016/j.amjsurg.2020.11.032. Epub 2020 Nov 17.
Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax.
We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases.
A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions.
For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days).
创伤性血胸在急性和慢性时期都存在诊断和治疗方面的挑战。东部创伤外科学会的一个工作组召开会议，制定了创伤性血胸的实践管理指南。
我们提出了四个问题：是否进行胸腔引流管或观察治疗，应放置猪尾导管还是胸腔引流管来引流血胸，在持续性血胸（rHTX）中是否应尝试溶栓治疗还是立即进行胸腔镜辅助引流（VATS），是否应早期（≤4 天）还是晚期（>4 天）进行 VATS？从多个数据库中确定的文章进行了系统评价。
共确定了 6391 篇文章，其中 14 篇被选为指南制定的依据。大多数文章是回顾性的，证据质量非常低。我们对其中三个问题的一些结果进行了荟萃分析。
对于创伤性血胸，我们有条件地推荐在血流动力学稳定的患者中使用猪尾导管。对于持续性血胸患者，我们有条件地推荐 VATS 而不是尝试溶栓治疗，并建议应尽早（≤4 天）进行。
