Effects of Different Treatment Regimens on Primary Spontaneous Pneumothorax: A Systematic Review and Network Meta-Analysis.

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic and Cardiovascular Surgery Pub Date : 2022-12-20 DOI:10.5761/atcs.oa.22-00113
Muredili Muhetaer, Keriman Paerhati, Qingchao Sun, Desheng Li, Liang Zong, Haiping Zhang, Liwei Zhang
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引用次数: 3

Abstract

Purpose: The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice.

Methods: Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate.

Results: In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: -2.5 [-4.63, -0.35]) and BT + apical pleurectomy (MD, 95% CI: -2.72 [-5.16, -0.27]).

Conclusions: Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.

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不同治疗方案对原发性自发性气胸的影响:系统综述和网络荟萃分析。
目的:原发性自发性气胸的最佳治疗策略存在争议,在实践中存在很大差异。方法:检索数据库至2021年8月24日的文献。采用贝叶斯网络meta分析比较不同治疗方法的预后,包括复发率、术后胸管时间、术后漏气时间、住院时间和并发症发生率。结果:共纳入20项随机对照试验和17项队列研究的7210例患者。手术的复发率明显低于其他治疗方法。此外,大泡切除术(BT)联合化学胸膜固定术(CP)、机械性胸膜固定术(机械性胸膜固定术)或钉线覆盖术(SLC)较单纯BT可降低复发率,但均无统计学意义。在缩短胸管时间方面,BT +管状Neoveil优于BT +胸膜磨损(平均差值[MD], 95%可信区间[CI]: -2.5[-4.63, -0.35])和BT +胸膜根尖切除术(MD, 95% CI: -2.72[-5.16, -0.27])。结论:手术方法在减少复发方面优于手工抽吸(MA)、胸管引流(CTD)和保守治疗。MA与CTD在降低复发率方面无显著差异。在手术方法中,CP比机械性胸膜固定术和基于BT的SLC更有效。
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来源期刊
Annals of Thoracic and Cardiovascular Surgery
Annals of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-SURGERY
CiteScore
2.80
自引率
0.00%
发文量
56
审稿时长
4-8 weeks
期刊介绍: Information not localized
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