Mott Children's Hospital, University of Michigan, Division of Pediatric Surgery, Ann Arbor, MI, USA.
Penn State Children's Hospital, Division of Pediatric Surgery, Hershey, PA, USA.
J Pediatr Surg. 2023 Oct;58(10):1873-1885. doi: 10.1016/j.jpedsurg.2023.03.018. Epub 2023 Apr 6.
Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations.
Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed.
Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24-48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment.
The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention.
Level 4.
Systematic Review of Level 1-4 studies.
青少年和年轻成人原发性自发性气胸的最佳治疗方法存在争议。美国儿外科协会（APSA）结果和循证实践委员会对文献进行了系统评价，以制定循证建议。
在 1990 年 1 月 1 日至 2020 年 12 月 31 日期间，通过 Ovid MEDLINE、Elsevier Embase、EBSCOhost CINAHL、Elsevier Scopus 和 Wiley Cochrane 对照试验中心注册数据库查询了与自发性气胸相关的文献，主要涉及（1）初始管理，（2）高级影像学，（3）手术时机，（4）手术技术，（5）对侧管理和（6）复发管理。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
共纳入 79 篇文献。青少年和年轻成人原发性自发性气胸的初始管理应根据症状进行，可包括观察、抽吸或胸腔引流。横断面成像没有获益证据。持续漏气的患者可能受益于 24-48 小时内早期手术干预。应考虑采用胸腔镜辅助手术（VATS）进行带钉的疱切除术和胸膜处理。没有证据支持预防性处理对侧。VATS 后复发可采用重复 VATS 并加强胸膜治疗。
青少年和年轻成人原发性自发性气胸的治疗方法多种多样。一些护理方面的最佳实践已经存在。需要进一步的前瞻性研究来更好地确定手术干预的最佳时机、最有效的手术方法以及观察、胸腔引流或手术干预后复发的处理方法。
4 级。
1-4 级研究的系统评价。
