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.	邱栋发, 黄窕妲, 李雄辉, 等.老年人自发性气胸56例临床分析.中国现代医学杂志, 2004, 14(3):103-104, 106.
3.	聂军, 贺大璞, 王元星, 等.胸腔镜治疗自发性气胸75例.中国内镜杂志, 2006, 12(6): 650-650, 655.
4.	贺大璞, 龙超众, 韦兵, 等. 136例胸腔镜手术临床应用分析.中国内镜杂志, 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.	沈祯云, 刘丹丹, 梁正, 等.腋下小切口与电视胸腔镜手术治疗自发性气胸疗效及费用比较.中国微创外科杂志, 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.自发性气胸行电视胸腔镜手术后复发的相关因素.中华胸心血管外科杂志, 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.	袁跃西, 钱勇, 罗化.自发性气胸外科手术治88例分析.中国现代医学杂志, 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.	张金伟, 张逊, 卢喜科, 等.胸腔镜肺大疱切除术中不同胸膜固定术的对比研究.天津医药, 2013, 41(4): 374-375.
25.	Cunnington J.自发性气胸的治疗.中国循证医学杂志, 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. 邱栋发, 黄窕妲, 李雄辉, 等.老年人自发性气胸56例临床分析.中国现代医学杂志, 2004, 14(3):103-104, 106.
3. 聂军, 贺大璞, 王元星, 等.胸腔镜治疗自发性气胸75例.中国内镜杂志, 2006, 12(6): 650-650, 655.
4. 贺大璞, 龙超众, 韦兵, 等. 136例胸腔镜手术临床应用分析.中国内镜杂志, 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. 沈祯云, 刘丹丹, 梁正, 等.腋下小切口与电视胸腔镜手术治疗自发性气胸疗效及费用比较.中国微创外科杂志, 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.自发性气胸行电视胸腔镜手术后复发的相关因素.中华胸心血管外科杂志, 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. 袁跃西, 钱勇, 罗化.自发性气胸外科手术治88例分析.中国现代医学杂志, 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. 张金伟, 张逊, 卢喜科, 等.胸腔镜肺大疱切除术中不同胸膜固定术的对比研究.天津医药, 2013, 41(4): 374-375.
25. Cunnington J.自发性气胸的治疗.中国循证医学杂志, 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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