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.
16.	袁振,刘典虎,何娟娟,等.胸膜粘连术治疗老年难治性、自发性气胸的临床研究.中国当代医药,2013,20(27):186-187,189.
17.	洪惠敏,江文益,吴英桂.胸腔内注入纤维蛋白原和凝血酶治疗难治性自发性气胸.吉林医学,2010,31(18):2782-2783.
18.	张卫珍,黎东明.胸腔内注入纤维蛋白原和凝血酶治疗难治性自发性气胸.右江医学,2004,32(2):106-108.
19.	胡文滕,蔺瑞江,滕元军,等.胸腔镜与开胸手术比较治疗自发性气胸效果的Meta分析.中国循证医学杂志,2014,14(8):927-933.
20.	郭焰.高渗葡萄糖联合红霉素行胸膜粘连术治疗持续性气胸的临床疗效观察.中国卫生产业,2014,10(3):101,103.
21.	陈学信,周洪恩,金发光,等.胸腔闭式引流胸膜粘连术治疗自发性气胸临床观察.现代医药卫生,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. 夏光进,丁玉江.胸腔闭式引流联合高聚生治疗复发性气胸疗效观察.临床肺科杂志,2006,11(4):525-526.
12. 陶仲为.自发性气胸诊治的五个问题.临床肺科杂志,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,刘典虎,何娟娟,等.胸膜粘连术治疗老年难治性、自发性气胸的临床研究.中国当代医药,2013,20(27):186-187,189.
17. 洪惠敏,江文益,吴英桂.胸腔内注入纤维蛋白原和凝血酶治疗难治性自发性气胸.吉林医学,2010,31(18):2782-2783.
18. 张卫珍,黎东明.胸腔内注入纤维蛋白原和凝血酶治疗难治性自发性气胸.右江医学,2004,32(2):106-108.
19. 胡文滕,蔺瑞江,滕元军,等.胸腔镜与开胸手术比较治疗自发性气胸效果的Meta分析.中国循证医学杂志,2014,14(8):927-933.
20. 郭焰.高渗葡萄糖联合红霉素行胸膜粘连术治疗持续性气胸的临床疗效观察.中国卫生产业,2014,10(3):101,103.
21. 陈学信,周洪恩,金发光,等.胸腔闭式引流胸膜粘连术治疗自发性气胸临床观察.现代医药卫生,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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