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laparoscopic 与在紧急情况下的开放性结肠直肠手术相比:一个系统的审查和元分析

Anne-Loes K Warps^1,2,3, Emma S Zwanenburg¹, Jan Willem T Dekker⁴

¹From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands.

Annals of surgery open : perspectives of surgical history, education, and clinical approaches

|August 28, 2023

概括

与开放手术相比, laparoscopic 紧急结直肠手术与较低的死亡率和发病率有关. 虽然有希望,但这些发现是基于观察性研究,需要谨慎的解释.

科学领域:

结肠直肠手术结肠直肠手术
最少侵入性的手术
外科手术的结果

背景情况:

腹腔镜技术在紧急结直肠外科手术中的有效性仍然不确定,与选择性手术不同.
这项研究解决了对腹腔镜方法在急性手术环境中的益处和风险的清晰度的需求.

研究的目的:

系统地审查和分析已发表的数据,比较腹腔镜和开放式急诊结肠直肠手术的结果.
确定死亡率的初级结果和二次结果,包括发病率和停留时间.

主要方法:

搜索主要数据库 (PubMed,Embase,Cochrane,CINAHL) 到2021年1月进行比较研究.
包括28项观察性研究和1项随机对照试验 (RCT).
使用柯克兰偏差风险工具和纽卡斯尔-太华尺度评估研究质量;进行随机效应元分析.

主要成果:

腹腔镜检查与术后死亡率 (OR 0.44) 和整体发病率 (OR 0.53) 的显著降低有关.
通过腹腔镜检查,观察到伤口感染,脱皮,腹膜,肺/心脏并发症的降低率.
经过腹腔镜手术的患者在医院停留时间较短.

结论:

laparoscopic 紧急结直肠手术显示出潜在的益处,包括降低死亡率和发病率.
这些发现,主要是从回顾性观察性研究中得出的,应根据潜在的偏见进行解释.
需要进一步进行高质量的研究,特别是RCT,以证实这些好处.

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