Effects of Closed Thoracic Drainage versus Closed Thoracic Drainage and Pleurodesis for Spontaneous Pneumothorax: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGLi-wei ¹ , LIShuang ¹ , ZHANGYu ² , WEINing ² , MAMin-jie ² ,  HANBiao ²

1. First Clinical Medical College, Lanzhou University, Lanzhou 730000, China;
2. First Hospital, Lanzhou University, Lanzhou 730000, China;

Corresponding?author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Closed drainage; Pleurodesis; Spontaneous pneumothorax; Systematic reviews; Meta-analysis; Randomized controlled triall

DOI：

10.7507/1672-2531.20150108

Video：

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Objective To systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax. Methods We searched PubMed, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI from their inception to December 2nd, 2014, to collect randomized controlled trials (RCTs) of simple closed drainage versus closed drainage combined with pleurodesis in the treatment of spontaneous pneumothorax. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 5 RCTs including 499 patients were included. The results of meta-analysis showed that:Compared with the simple closed drainage, the closed drainage combined with pleurodesis was superior in the effective rate of recurrence spontaneous pneumothorax (OR=6.85, 95%CI 3.26 to 14.39, P<0.000 01) and the recurrence rate of primary spontaneous pneumothorax (OR=0.32, 95%CI 0.18 to 0.57, P<0.001). But there were no statistical differences in both groups in the effective rate of primary spontaneous pneumothorax (OR=1.49, 95%CI 0.71 to 3.14, P=0.29), the hospital stays of primary spontaneous pneumothorax (SMD=0.08, 95%CI -0.16 to 0.31, P=0.52), the hospital stays of recurrence spontaneous pneumothorax (SMD=-1.67, 95%CI -3.96 to 0.61, P=0.15), and the duration of drainage of primary spontaneous pneumothorax (SMD=-0.11, 95%CI 0.79 to 0.58, P=0.76). Conclusion Current evidence suggests that closed drainage combined with pleurodesis could improve the effective rate of recurrence spontaneous pneumothorax and decrease the recurrence rate of primary spontaneous pneumothorax. Due to limited quantity and quality of included studies, the above conclusion should be validated by more high quality studies.

Citation： WANGLi-wei, LIShuang, ZHANGYu, WEINing, MAMin-jie, HANBiao. Effects of Closed Thoracic Drainage versus Closed Thoracic Drainage and Pleurodesis for Spontaneous Pneumothorax: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 646-651. doi: 10.7507/1672-2531.20150108 Copy

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15.	Almind M,Lange P,Viskum K.Spontaneous pneumothorax:comparison of simple drainage,talc pleurodesis,and tetracycline pleurodesis.Thorax,1989,44(8):627-630.
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19.	胡文滕,藺瑞江,滕元軍,等.胸腔鏡與開胸手術比較治療自發性氣胸效果的Meta分析.中國循證醫學雜志,2014,14(8):927-933.
20.	郭焰.高滲葡萄糖聯合紅霉素行胸膜粘連術治療持續性氣胸的臨床療效觀察.中國衛生產業,2014,10(3):101,103.
21.	陳學信,周洪恩,金發光,等.胸腔閉式引流胸膜粘連術治療自發性氣胸臨床觀察.現代醫藥衛生,2009,25(24):3761-3762.

1. Sahn SA,Heffner JE.Spontaneous pneumothorax.N Engl J Med,2000,342(12):868-874.
2. Lichter J,Gwynne JF.Spontaneous pneumothorax in young subjects.Thorax,1971,25(3):409-417.
3. Light RW.Management of spontaneous pneumothorax.Am Rev Respir Dis,1993,148(1):245-258.
4. MacDuff A,Arnold A,Harvey J,BTS Pleural Disease Guideline Group.Management of spontaneous pneumothorax:British Thoracic Society pleural disease guideline 2010.Thorax,2010,65(suppl 2):ii18-31.
5. Baumann MH,Strange C,Heffner JE,et al.Management of spontaneous pneumothorax:an American College of Chest Physicians Delphi consensus statement.Chest,2001,119(2):590-602.
6. Seremetis MG.The management of spontaneous pneumothorax.Chest,1970,57(1):65-68.
7. Gobbel WG Jr,Rhea WG Jr.Spontaneous pneumothorax.J Thorac Cardiovasc Surg,1963,46(3):331-345.
8. Voge VM,Anthracite R.Spontaneous pneumothorax in the USAF aircrew population:a retrospective study.Aviat Space Environ Med,1986,57(10 Pt 1):939-949.
9. Tschopp JM,Rami-Porta R,Noppen M,et al.Management of spontaneous pneumothorax:state of the art.Eur Respir J,2006,28(3):637-650.
10. Margolis M,Gharagozloo F,Tempesta B,et al.Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients.Ann Thorac Surg,2003,76(5):1661-1663.
11. 夏光進,丁玉江.胸腔閉式引流聯合高聚生治療復發性氣胸療效觀察.臨床肺科雜志,2006,11(4):525-526.
12. 陶仲為.自發性氣胸診治的五個問題.臨床肺科雜志,2004,9(3):205-206.
13. Julian PT Higgins.Sally Green.Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0).Available at:http://handbook.cochrane.org/.
14. Chen JS,Chan WK,Tsai KT,et al.Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax:an open-label,parallel-group,prospective,randomised,controlled trial.Lancet,2013,381(9874):1277-1282.
15. Almind M,Lange P,Viskum K.Spontaneous pneumothorax:comparison of simple drainage,talc pleurodesis,and tetracycline pleurodesis.Thorax,1989,44(8):627-630.
16. 袁振,劉典虎,何娟娟,等.胸膜粘連術治療老年難治性、自發性氣胸的臨床研究.中國當代醫藥,2013,20(27):186-187,189.
17. 洪惠敏,江文益,吳英桂.胸腔內注入纖維蛋白原和凝血酶治療難治性自發性氣胸.吉林醫學,2010,31(18):2782-2783.
18. 張衛珍,黎東明.胸腔內注入纖維蛋白原和凝血酶治療難治性自發性氣胸.右江醫學,2004,32(2):106-108.
19. 胡文滕,藺瑞江,滕元軍,等.胸腔鏡與開胸手術比較治療自發性氣胸效果的Meta分析.中國循證醫學雜志,2014,14(8):927-933.
20. 郭焰.高滲葡萄糖聯合紅霉素行胸膜粘連術治療持續性氣胸的臨床療效觀察.中國衛生產業,2014,10(3):101,103.
21. 陳學信,周洪恩,金發光,等.胸腔閉式引流胸膜粘連術治療自發性氣胸臨床觀察.現代醫藥衛生,2009,25(24):3761-3762.

Chinese Journal of Evidence-Based Medicine

Effects of Closed Thoracic Drainage versus Closed Thoracic Drainage and Pleurodesis for Spontaneous Pneumothorax: A Meta-analysis

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