From the Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK.
Department of Respiratory Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
QJM. 2022 Apr 20;115(4):215-221. doi: 10.1093/qjmed/hcab020.
At least a third of patients go on to suffer a recurrence following a first spontaneous pneumothorax. Surgical intervention reduces the risk of recurrence and has been advocated as a primary treatment for pneumothorax. But surgery exposes patients to the risks of anaesthesia and in some cases can cause chronic pain. Risk stratification of patients to identify those most at risk of recurrence would help direct the most appropriate patients to early intervention. Many studies have addressed the role of thoracic computerized tomography (CT) in identifying those individuals at increased risk of recurrence, but a consensus is lacking.
Our objective was to clarify whether CT provides valuable prognostic information for recurrent pneumothorax.
Meta-analysis.
We conducted an exhaustive search of the literature for thoracic CT imaging and pneumothorax, and then performed a meta-analysis using a random effects model to estimate the common odds ratio and standard error.
Here, we show by meta-analysis of data from 2475 individuals that emphysematous change on CT scan is associated with a significant increased odds ratio for recurrent pneumothorax ipsilateral to the radiological abnormality (odds ratio 2.49, 95% confidence interval 1.51-4.13).
The association holds true for primary spontaneous pneumothorax when considering emphysematous changes including blebs and bullae. Features, such as bullae at the azygoesophageal recess or increased Goddard score similarly predicted recurrent secondary pneumothorax, as shown by subgroup analysis. Our meta-analysis suggests that CT scanning has value in risk stratifying patients considering surgery for pneumothorax.
至少有三分之一的患者在首次自发性气胸后会再次发作。手术干预可降低复发风险，因此被推荐作为气胸的主要治疗方法。但是手术会使患者面临麻醉风险，并且在某些情况下会导致慢性疼痛。对患者进行风险分层以确定最易复发的患者，可以帮助指导最合适的患者进行早期干预。许多研究都探讨了胸部计算机断层扫描（CT）在识别那些复发风险增加的个体中的作用，但尚未达成共识。
我们的目的是阐明 CT 是否为复发性气胸提供有价值的预后信息。
荟萃分析。
我们对有关胸部 CT 成像和气胸的文献进行了详尽的搜索，然后使用随机效应模型进行荟萃分析，以估计常见的优势比和标准误差。
在这里，我们通过对 2475 个人的数据进行荟萃分析表明，CT 扫描上的气肿性改变与同侧放射异常的复发性气胸的显著增加的优势比相关（优势比 2.49，95％置信区间 1.51-4.13）。
在考虑包括疱和大疱在内的气肿性改变时，原发性自发性气胸的相关性成立。通过亚组分析表明，诸如在咽食管隐窝处的大疱或增加的 Goddard 评分等特征同样可以预测复发性继发性气胸。我们的荟萃分析表明，CT 扫描在考虑气胸手术的患者进行风险分层方面具有价值。
