背景:手术是原发性自发性气胸最有效的治疗方法。最广泛采用的两种手术方法是机械擦伤和根尖胸膜切除术,除了肿瘤切除术。我们进行了系统评价和荟萃分析,以检查哪种技术在治疗原发性自发性气胸方面更优越。
方法:PubMed,在MEDLINE和EMBASE数据库中搜索了2000年1月至2022年9月之间发表的比较机械擦伤和根尖胸膜切除术治疗原发性自发性气胸的研究。主要结果是气胸复发。次要结果包括术后胸管持续时间,住院时间,手术时间和术中失血。
结果:8项研究符合纳入条件,涉及1,613例患者。胸膜磨损和胸膜切除术之间的气胸复发率没有差异(RR:1.34;95%CI:0.94至1.92)。然而,胸膜磨损导致住院时间缩短(MD:-0.25;95%CI:-0.51至0.00),术后胸管持续时间(MD:-0.30;95%CI:-0.56至-0.03),手术时间(MD:-13.00;95%CI-15.07~10.92)和手术失血较少(MD:-17.77;95%CI:-24.36~-11.18)。
结论:与胸膜切除术相比,胸膜磨损可减少患者的围手术期负担,缩短住院时间,而不会影响气胸的复发率。因此,胸膜擦伤是治疗原发性自发性气胸的合理首选手术方法。
BACKGROUND: Surgical approach is the most effective treatment for primary spontaneous pneumothorax. The two most widely adopted surgical methods are mechanical abrasion and apical
pleurectomy, in addition to bullectomy. We performed a systematic review and meta-analysis to examine which technique is superior in treating primary spontaneous pneumothorax.
METHODS: PubMed, MEDLINE and EMBASE databases were searched for studies published between January 2000 to September 2022 comparing mechanical abrasion and apical
pleurectomy for treatment of primary spontaneous pneumothorax. The primary outcome was pneumothorax recurrence. Secondary outcomes included post-operative chest tube duration, hospital length of stay, operative time and intra-operative of blood loss.
RESULTS: Eight studies were eligible for inclusion involving 1,613 patients. There was no difference in the rate of pneumothorax recurrence between pleural abrasion and
pleurectomy (RR: 1.34; 95% CI: 0.94 to 1.92). However, pleural abrasion led to shorter hospital length of stay (MD: -0.25; 95% CI: -0.51 to 0.00), post-operative chest tube duration (MD: -0.30; 95% CI: -0.56 to -0.03), operative time (MD: -13.00; 95% CI -15.07 to 10.92) and less surgical blood loss (MD: -17.77; 95% CI: -24.36 to -11.18).
CONCLUSIONS: Pleural abrasion leads to less perioperative patient burden and shorter hospital length of stay without compromising the rate of pneumothorax recurrence when compared to
pleurectomy. Thus, pleural abrasion is a reasonable first choice surgical procedure for management of primary spontaneous pneumothorax.