Chang Po-Chih, Chen Kai-Hua, Jhou Hong-Jie, Lee Cho-Hao, Chou Shah-Hwa, Chen Po-Huang, Chang Ting-Wei
Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan.
Weight Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan.
J Pers Med. 2022 Mar 22;12(4):512. doi: 10.3390/jpm12040512.
The chest tube drainage system (CTDS) of choice for the pleural cavity after pulmonary resection remains controversial. This systematic review and network meta-analysis (NMA) aimed to assess the length of hospital stay, chest tube placement duration, and prolonged air leak among different types of CTDS.
This systemic review and NMA included 21 randomized controlled trials (3399 patients) in PubMed and Embase until 1 June 2021. We performed a frequentist random effect in our NMA, and a P-score was adopted to determine the best treatment. We assessed the clinical efficacy of different CTDSs (digital/suction/non-suction) using the length of hospital stay, chest tube placement duration, and presence of prolonged air leak.
Based on the NMA, digital CTDS was the most beneficial intervention for the length of hospital stay, being 1.4 days less than that of suction CTDS (mean difference (MD): -1.40; 95% confidence interval (CI): -2.20 to -0.60). Digital CTDS also had significantly reduced chest tube placement duration, being 0.68 days less than that of suction CTDSs (MD: -0.68; 95% CI: -1.32 to -0.04). Neither digital nor non-suction CTDS significantly reduced the risk of prolonged air leak.
Digital CTDS is associated with better outcomes than suction and non-suction CTDS for patients undergoing pulmonary resections, specifically 0.68 days shorter chest tube duration and 1.4 days shorter hospital stay than suction CTDS.
肺切除术后胸腔引流首选的胸管引流系统（CTDS）仍存在争议。本系统评价和网状Meta分析（NMA）旨在评估不同类型CTDS的住院时间、胸管留置时间和持续性漏气情况。
本系统评价和NMA纳入了截至2021年6月1日在PubMed和Embase数据库中的21项随机对照试验（3399例患者）。我们在NMA中采用了频率学派随机效应模型，并采用P值法确定最佳治疗方案。我们使用住院时间、胸管留置时间和持续性漏气情况来评估不同CTDS（数字式/负压吸引式/非负压吸引式）的临床疗效。
基于NMA，数字式CTDS对住院时间的影响最为有利，比负压吸引式CTDS缩短1.4天（平均差值（MD）：-1.40；95%置信区间（CI）：-2.20至-0.60）。数字式CTDS的胸管留置时间也显著缩短，比负压吸引式CTDS缩短0.68天（MD：-0.68；95%CI：-1.32至-0.04）。数字式和非负压吸引式CTDS均未显著降低持续性漏气的风险。
对于接受肺切除术的患者，数字式CTDS比负压吸引式和非负压吸引式CTDS具有更好的疗效，特别是胸管留置时间比负压吸引式CTDS缩短0.68天，住院时间缩短1.4天。
