预防性关闭可以改善结直肠内镜下粘膜剖析后的结果吗? 一个系统性审查和元分析
Liang Dong1, Weihua Zhu, Xiaolei Zhang
1Department of Gastroenterology, Huzhou Central Hospital, Huzhou, Zhejiang Province, China.
Surgical laparoscopy, endoscopy & percutaneous techniques
|November 27, 2023
概括
在内镜下膜剖析 (ESD) 后的预防性关闭可能会减少延迟出血,特别是在观察性研究中. 然而,随机对照试验 (RCT) 没有证实这种益处,并且关闭并没有影响穿孔或ESD后凝血综合征风险.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 结肠直肠手术 结肠直肠手术
背景情况:
- 内镜下粘膜切割 (ESD) 是消除结直肠病变的关键技术.
- 经过ESD后的术后结果,包括出血和穿孔,是一个重大问题.
- 正在探索预防性关闭技术以减轻这些风险.
研究的目的:
- 系统地审查和分析关于结直肠ESD后预防性关闭疗效的证据.
- 评估预防性关闭对延迟出血,穿孔和ESD后凝血综合征 (PECS) 的影响.
主要方法:
- 在PubMed,Embase,CENTRAL和Web of Science的综合文献搜索到2023年7月9日.
- 包括所有类型的比较研究,包括随机对照试验 (RCT) 和观察性研究.
- 来自十项纳入研究的汇总数据的元分析 (939名关闭患者与1074名对照).
主要成果:
- 在聚合数据中,预防性关闭与延迟出血的发病率降低有关 (OR:0.30),主要是由观察性研究驱动的.
- 这种延迟出血的减少仅在RCT中并不具有统计学意义.
- 在关闭和非关闭组之间,在延迟穿孔 (OR:0.55) 或PECS (OR:1.15) 的风险上没有发现显著差异.
结论:
- 观察数据表明,预防性关闭在减少结肠直肠ESD后延迟出血方面具有潜在的益处.
- 随机试验并没有证实有关延迟出血减少的发现.
- 预防性关闭似乎对延迟穿孔或PECS的风险没有重大影响.
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