ObjectiveTo systematically review the clinical effects and safety of thoracoscopy operation and thoracotomy for spontaneous pneumothorax. MethodsWe 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. ResultsA 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). ConclusionCompared 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.
ObjectiveTo systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax. MethodsWe 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. ResultsA 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). ConclusionCurrent 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.
ObjectiveTo systematically review the efficacy and safety of laparoscopic Heller's myotomy (LHM) versus pneumatic dilatation (PD) for achalasia. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), Web of Knowledge, CNKI, CBM, WanFang Data and VIP were searched from inception to August 26th 2015, to collect randomized controlled trials (RCTs) of LHM versus PD for achalasia. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 446 patients were included. The results of meta-analysis showed that, compared with PD, LHM could significantly improve the effective rates after 3-month and 1-year follow-up (OR=2.66, 95%CI 1.08 to 6.60, P=0.03; OR=2.24, 95%CI 1.29 to 3.87, P=0.004). There were no statistical differences between the two groups in effective rate after more than 2-year follow-up (OR=1.749, 95%CI 0.99 to 3.23, P=0.05) and incidence of complications (OR=0.27, 95%CI 0.06 to 1.13, P=0.07). ConclusionCurrent evidence shows that, compared with PD, LHM could improve the short-term effective rate but could not improve the long-term (2-3 years) effective rate and reduce the incidence of complications. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the impact of side-to-side esophagogastric anastomosis on postoperative anastomostic leak, fibrosis stricture and stroesophageal reflux. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 4 2015), Web of Science, CNKI, CBM, Wanfang Database and VIP up to April 2015. Randomized controlled trials involving the complications after side-to-side esophagogastric anastomosis were included. Data were extracted and methodological quality was evaluated by two reviewers independently with a designed extraction form. Then RevMan 5.3 software was used for meta-analysis. ResultsA total of 7 studies involving 684 patients were included. The results of meta-analysis showed that comparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidence of fibrosis stricture with RR=0.20 and 95% CI 0.11 to 0.36 (P<0.000 01). There was no statistical difference in incidence of postoperative anasotmostic leaks with RR=0.71 and 95% CI 0.43 to 1.19 (P=0.19) or stroesophageal reflux with RR=0.74 and 95% CI 0.50 to 1.11 (P=0.15) between the two groups. ConclusionComparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidences of fibrosis stricture, but there is no statistical difference in anastomostic leak or stroesophageal reflux.
ObjectiveTo summarize the types of difficult cases and complications during interventional therapy for Budd-Chiari syndrome, and to propose solutions to these problems and complications. MethodsClinical data of 1 859 cases of Budd-Chiari syndrome (2 214 times) who underwent interventional diagnosis and therapy from Jan. 1990 to Sep. 2014 in our hospital were retrospectively analyzed. ResultsOf the 2 214 times, complications happened in 31 times, which were related to the interventional therapy, and the incidence of complication was 1.40% (31/2 214). Of the 31 times who suffered from complications, 25 times were successfully treated, and the successful rate was 80.65%. Three hundreds and seventy two times had been successful treated in 396 times with difficult situation (there were 9 times without treatment), and the successful rate was 96.12% (372/387). Seven patients abandoned inteventional therapy. Six cases died during the operation and hospital stay period, and the mortality was 0.32% (6/1 852). There were 1 553 cases were followed-up for 10-284 months (average of 100.9 months). During the follow-up period, 209 cases suffered from restenosis, and the restenosis rate was 13.46% (209/1 553). ConclusionInterventional therapy for Budd-Chiari syndrome has entered a mature stage, discover timely and correct handling of intraoperative complications are important to improve the successful rate and curative effect.
ObjectiveTo systematically review the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) for esophagus cancer patients after esophagectomy. MethodsThe following electronic databases as PubMed, EMbase, The Cochrane Library (Issue 6, 2016), Web of Science, CBM, WanFang Data and CNKI were searched from inception to June 2016 to collect randomized controlled trials (RCTs) on comparing early EN and PN for esophagus cancer patients after esophagectomy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 14 RCTs involving 2 275 patients were included. The results of meta-analysis showed that, compared with the PN group, the early EN group could improve postoperative levels of albumin (MD=1.12, 95%CI 0.03 to 2.20, P=0.04) and transferrin (MD=10.08, 95%CI 5.41 to 14.76, P<0.000 1), decrease the incidences of pulmonary infection (OR=0.36, 95%CI 0.25 to 0.53, P<0.000 01) and anastomotic leakage (OR=0.57, 95%CI 0.36 to 0.92, P=0.02), but there was no significant difference in postoperative level of prealbumin between two groups (MD=10.04, 95%CI -0.31 to 20.39, P=0.06). ConclusionThe early EN could improve the postoperative levels of albumin and transferrin, decrease the incidences of pulmonary infection and anastomotic leakage, but could not improve the postoperative prealbumin level.