Efficacy of Thoracoscopy versus Thoracotomy for Spontaneous Spneumothorax: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HUWen-teng ¹ , LINRui-jiang ¹ , TENGYuan-jun ² , WEINing ³ , MAMin-jie ³ ,  HANBiao ³

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

Corresponding?author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Spontaneous pneumothorax; Thoracoscopy; Thoracotomy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140155

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Objective To systematically review the clinical effects and safety of thoracoscopy operation and thoracotomy for spontaneous pneumothorax. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), Web of Knowledge, CNKI, CBM, WanFang Data and VIP up to October 2013. Randomized controlled trials involving treatment outcomes of spontaneous pneumothorax using thoracoscopy compared with thoracotomy were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then RevMan 5.2 software was used for meta-analysis. Results A total of 7 studies involving 481 patients were included. The results of meta-analysis showed that the operative time in the thoracoscopy goup was significantly longer than that in the thoracotomy group (MD=13.57, 95%CI 3.58 to 23.56, P=0.008). But there was no significant difference in recurrence rates (RR=3.16, 95%CI 0.84 to 11.94, P=0.09), total postoperative complications (RR=1.33, 95%CI 0.46 to 3.88, P=0.46), postoperative chest drainage time (MD=-0.00, 95%CI-0.64 to-0.63, P=0.99), and hospitalization time (MD=0.09, 95%CI-0.21 to 0.40, P=0.55). Conclusion Compared with thoracotomy, thoracoscopy does not increase recurrence rates, postoperative complications, chest drainage time or hospitalization time, but it could prolong operation time in a certain extent.

Citation： HUWen-teng, LINRui-jiang, TENGYuan-jun, WEINing, MAMin-jie, HANBiao. Efficacy of Thoracoscopy versus Thoracotomy for Spontaneous Spneumothorax: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 927-933. doi: 10.7507/1672-2531.20140155 Copy

1.	?MacDuff A, Arnold A and Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2): ii18-31.
2.	邱棟發, 黃窕妲, 李雄輝, 等.老年人自發性氣胸56例臨床分析.中國現代醫學雜志, 2004, 14(3):103-104, 106.
3.	聶軍, 賀大璞, 王元星, 等.胸腔鏡治療自發性氣胸75例.中國內鏡雜志, 2006, 12(6): 650-650, 655.
4.	賀大璞, 龍超眾, 韋兵, 等. 136例胸腔鏡手術臨床應用分析.中國內鏡雜志, 2009, 15(4): 392-394.
5.	Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest, 2005, 127(6): 2226-2230.
6.	Ayed AK and Al-Din HJ. Video-assisted thoracoscopy versus thoracotomy for primary spontaneous pneumothorax: a randomized controlled trial. Med Prin Pract, 2000, 9(2): 113-118.
7.	沈禎云, 劉丹丹, 梁正, 等.腋下小切口與電視胸腔鏡手術治療自發性氣胸療效及費用比較.中國微創外科雜志, 2001, 1(2): 85-87.
8.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). [cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org.
9.	Foroulis CN, Anastasiadis K, Charokopos N, et al. A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study. Surg Endosc, 2012, 26(3): 607-614.
10.	Freixinet JL, Canalis E, Julia G, et al. Axillary thoracotomy versus videothoracoscopy for the treatment of primary spontaneous pneumothorax. Ann Thorac Surg, 2004, 78(2): 417-420.
11.	Gebhard FT, Becker HP, Gerngross H, et al. Reduced inflammatory response in minimal invasive surgery of pneumothorax. Archives of Surgery, 1996, 131(10): 1079-1082.
12.	Sekine Y, Miyata Y, Yamada K, et al. Video-assisted thoracoscopic surgery does not deteriorate postoperative pulmonary gas exchange in spontaneous pneumothorax patients. Eur J Cardiothorac Surg, 1999, 16(1): 48-53.
13.	Waller DA, Forty J, Morritt GN. Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg, 1994, 58(2): 372-377.
14.	Li ZJ, Zhang Y, Fu T, et al. Evaluation of curative effects of axillary thoracotomy and videothoracoscopy in treatment for primary spontaneous pneumothorax. Journal of Jilin University Medicine Edition, 2006, 32(4): 711-713.
15.	Gossot D, Galetta D, Stern JB, et al. Results of thoracoscopic pleural abrasion for primary spontaneous pneumothorax. Surg Endosc, 2004, 18(3): 466-471.
16.	Luh SP, Tsai TP, Chou MC, et al. Video-assisted thoracic surgery for spontaneous pneumothorax: outcome of 189 cases. Int Surg, 2004, 89(4): 185-189.
17.	Sakamoto K, Takei H, Nishii T, et al. Staple line coverage with absorbable mesh after thoracoscopic bullectomy for spontaneous pneumothorax. Surg Endosc, 2004, 18(3): 478-481.
18.	卜梁, 姜冠潮, 王俊.自發性氣胸行電視胸腔鏡手術后復發的相關因素.中華胸心血管外科雜志, 2007, 23(6): 416.
19.	Cardillo G, Facciolo F, Regal M, et al. Recurrences following videothoracoscopic treatment of primary spontaneous pneumothorax: the role of redo-videothoracoscopy. Eur J Cardiothorac Surg, 2001, 19(4): 396-399.
20.	Casadio C, Rena O, Giobbe R, et al. Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax. J Cardiovasc Surg (Torino), 2002, 43(2): 259-262.
21.	Horio H, Nomori H, Kobayashi R, et al. Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax. Surg Endosc, 2002, 16(4): 630-634.
22.	袁躍西, 錢勇, 羅化.自發性氣胸外科手術治88例分析.中國現代醫學雜志, 2009, 19(12): 1882-1883, 1887.
23.	Sepehripour AH, Nasir A and Shah R. Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg, 2012, 14(3): 307-311.
24.	張金偉, 張遜, 盧喜科, 等.胸腔鏡肺大皰切除術中不同胸膜固定術的對比研究.天津醫藥, 2013, 41(4): 374-375.
25.	Cunnington J.自發性氣胸的治療.中國循證醫學雜志, 2004, 4(3): 202-204.
26.	Al-Tarshihi MI. Comparison of the efficacy and safety of video-assisted thoracoscopic surgery with the open method for the treatment of primary pneumothorax in adults. Ann Thorac Med, 2008, 3(1): 9-12.

1. ?MacDuff A, Arnold A and Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2): ii18-31.
2. 邱棟發, 黃窕妲, 李雄輝, 等.老年人自發性氣胸56例臨床分析.中國現代醫學雜志, 2004, 14(3):103-104, 106.
3. 聶軍, 賀大璞, 王元星, 等.胸腔鏡治療自發性氣胸75例.中國內鏡雜志, 2006, 12(6): 650-650, 655.
4. 賀大璞, 龍超眾, 韋兵, 等. 136例胸腔鏡手術臨床應用分析.中國內鏡雜志, 2009, 15(4): 392-394.
5. Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest, 2005, 127(6): 2226-2230.
6. Ayed AK and Al-Din HJ. Video-assisted thoracoscopy versus thoracotomy for primary spontaneous pneumothorax: a randomized controlled trial. Med Prin Pract, 2000, 9(2): 113-118.
7. 沈禎云, 劉丹丹, 梁正, 等.腋下小切口與電視胸腔鏡手術治療自發性氣胸療效及費用比較.中國微創外科雜志, 2001, 1(2): 85-87.
8. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). [cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org.
9. Foroulis CN, Anastasiadis K, Charokopos N, et al. A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study. Surg Endosc, 2012, 26(3): 607-614.
10. Freixinet JL, Canalis E, Julia G, et al. Axillary thoracotomy versus videothoracoscopy for the treatment of primary spontaneous pneumothorax. Ann Thorac Surg, 2004, 78(2): 417-420.
11. Gebhard FT, Becker HP, Gerngross H, et al. Reduced inflammatory response in minimal invasive surgery of pneumothorax. Archives of Surgery, 1996, 131(10): 1079-1082.
12. Sekine Y, Miyata Y, Yamada K, et al. Video-assisted thoracoscopic surgery does not deteriorate postoperative pulmonary gas exchange in spontaneous pneumothorax patients. Eur J Cardiothorac Surg, 1999, 16(1): 48-53.
13. Waller DA, Forty J, Morritt GN. Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg, 1994, 58(2): 372-377.
14. Li ZJ, Zhang Y, Fu T, et al. Evaluation of curative effects of axillary thoracotomy and videothoracoscopy in treatment for primary spontaneous pneumothorax. Journal of Jilin University Medicine Edition, 2006, 32(4): 711-713.
15. Gossot D, Galetta D, Stern JB, et al. Results of thoracoscopic pleural abrasion for primary spontaneous pneumothorax. Surg Endosc, 2004, 18(3): 466-471.
16. Luh SP, Tsai TP, Chou MC, et al. Video-assisted thoracic surgery for spontaneous pneumothorax: outcome of 189 cases. Int Surg, 2004, 89(4): 185-189.
17. Sakamoto K, Takei H, Nishii T, et al. Staple line coverage with absorbable mesh after thoracoscopic bullectomy for spontaneous pneumothorax. Surg Endosc, 2004, 18(3): 478-481.
18. 卜梁, 姜冠潮, 王俊.自發性氣胸行電視胸腔鏡手術后復發的相關因素.中華胸心血管外科雜志, 2007, 23(6): 416.
19. Cardillo G, Facciolo F, Regal M, et al. Recurrences following videothoracoscopic treatment of primary spontaneous pneumothorax: the role of redo-videothoracoscopy. Eur J Cardiothorac Surg, 2001, 19(4): 396-399.
20. Casadio C, Rena O, Giobbe R, et al. Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax. J Cardiovasc Surg (Torino), 2002, 43(2): 259-262.
21. Horio H, Nomori H, Kobayashi R, et al. Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax. Surg Endosc, 2002, 16(4): 630-634.
22. 袁躍西, 錢勇, 羅化.自發性氣胸外科手術治88例分析.中國現代醫學雜志, 2009, 19(12): 1882-1883, 1887.
23. Sepehripour AH, Nasir A and Shah R. Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg, 2012, 14(3): 307-311.
24. 張金偉, 張遜, 盧喜科, 等.胸腔鏡肺大皰切除術中不同胸膜固定術的對比研究.天津醫藥, 2013, 41(4): 374-375.
25. Cunnington J.自發性氣胸的治療.中國循證醫學雜志, 2004, 4(3): 202-204.
26. Al-Tarshihi MI. Comparison of the efficacy and safety of video-assisted thoracoscopic surgery with the open method for the treatment of primary pneumothorax in adults. Ann Thorac Med, 2008, 3(1): 9-12.

Chinese Journal of Evidence-Based Medicine

Efficacy of Thoracoscopy versus Thoracotomy for Spontaneous Spneumothorax: A Meta-Analysis

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