. Centro Universitário de João Pessoa, João Pessoa (PB) Brasil.
. Universidade de Pernambuco, Recife (PE) Brasil.
J Bras Pneumol. 2024 Aug 19;50(3):e20240115. doi: 10.36416/1806-3756/e20240115. eCollection 2024.
Talc pleurodesis is a widely used treatment option for malignant pleural effusion (MPE). However, the optimal form of administration remains controversial. Thus, we performed a systematic review and meta-analysis to assess the effectiveness of talc slurry (TS) in comparison with thoracoscopic talc insufflation/poudrage (TTI) for MPE treatment.
We searched PubMed, EMBASE, and Cochrane Library databases for studies that compared TS with TTI in patients with MPE. We used a random-effects model with a 95% CI to pool the data. Heterogeneity was assessed with I2 statistics.
We included eight studies involving 1,163 patients, 584 of whom (50.21%) underwent TS. Pleurodesis failure rates were similar between the procedures (OR = 1.07; 95% CI: 0.56-2.06; p = 0.83; I2 = 62%); and 68% of patients (95% CI: 0.31-1.47; p = 0.33; I2 = 58%) had postoperative complications, which were lower in patients in the TS group than in the TTI group. In a subgroup analysis considering only randomized clinical trials, the failure rate was significantly lower in the TS treatment group (OR = 0.62; 95% CI: 0.42-0.90; p = 0.01; I2 = 0%). Similarly, dyspnea was less common in the TS group (OR = 0.74; 95% CI: 0.41-1.34; p = 0.32; I2 = 55%). Adverse effects were reported in 86 patients, and no significant difference was seen between the TS and TTI groups: empyema (OR = 1.43; 95% CI: 0.36-5.64; p = 0.86; I2 = 0%), pain (OR = 1.22 (95% CI: 0.67-2.21; p = 0.51; I2 = 38%), and pneumonia (OR = 1.15; 95% CI: 0.30-4.46; p = 0.86; I2 = 27%).
Our findings suggest that TS is an effective treatment for MPE, with no significant increase in adverse events. Results suggest equivalent efficacy and safety for both procedures.
滑石粉胸膜固定术是治疗恶性胸腔积液（MPE）的常用方法。然而，最佳给药方式仍存在争议。因此，我们进行了系统评价和荟萃分析，以评估滑石粉混悬液（TS）与胸腔镜滑石粉灌输/撒粉（TTI）治疗 MPE 的疗效。
我们检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库，以比较 TS 与 TTI 在 MPE 患者中的应用。我们使用随机效应模型和 95%置信区间（CI）来汇总数据。使用 I2 统计量评估异质性。
我们纳入了八项研究，共涉及 1163 名患者，其中 584 名（50.21%）接受了 TS 治疗。两种方法的胸膜固定术失败率相似（OR=1.07；95%CI：0.56-2.06；p=0.83；I2=62%）；68%的患者（95%CI：0.31-1.47；p=0.33；I2=58%）出现术后并发症，TS 组的并发症发生率低于 TTI 组。在仅考虑随机临床试验的亚组分析中，TS 治疗组的失败率显著降低（OR=0.62；95%CI：0.42-0.90；p=0.01；I2=0%）。同样，TS 组呼吸困难的发生率较低（OR=0.74；95%CI：0.41-1.34；p=0.32；I2=55%）。86 例患者报告了不良反应，TS 组和 TTI 组之间无显著差异：脓胸（OR=1.43；95%CI：0.36-5.64；p=0.86；I2=0%）、疼痛（OR=1.22（95%CI：0.67-2.21；p=0.51；I2=38%）和肺炎（OR=1.15；95%CI：0.30-4.46；p=0.86；I2=27%）。
我们的研究结果表明，TS 是治疗 MPE 的有效方法，且不良反应无显著增加。结果表明两种方法的疗效和安全性相当。
