神经神经调节治疗异常慢过渡性便秘的有效性,安全性和成本效益:系统性审查
Stella C M Heemskerk1,2,3, Aart A van der Wilt3, Bart M F Penninx4
1Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands.
概括
圣神经调节 (SNM) 治疗耐火慢通道便秘的有效性和成本效益尚不确定. 报告称,高达29%的重复手术率,突出显示了这种微创治疗的安全性问题.
科学领域:
- 胃肠病学和肝病学
- 手术创新 在外科创新.
- 卫生经济学 卫生经济学
背景情况:
- 圣神经调节 (SNM) 是功能性便秘的最小侵入性选择.
- 关于SNM对耐火性异常慢通便秘 (STC) 的有效性的现有证据是矛盾的.
- 研究群体和研究设计的异质性导致了相互矛盾的结果.
研究的目的:
- 评估SNM在儿科和成人患者中耐火性异常性STC的有效性.
- 评估SNM在这个患者群体中的安全性.
- 为了确定SNM与标准治疗相比的成本效益.
主要方法:
- 在多个数据库 (OVID Medline,Embase,Cochrane等) 中进行全面的文献搜索. 在2023年5月之前.
- 包括随机对照试验 (RCT) 的有效性,所有研究设计的安全性,和经济评估的成本效益.
- 由两名审稿人对研究选择,偏差风险,质量评估和数据提取的独立审查.
主要成果:
- 只有两个RCT被确定为有效性,在排便频率和便秘严重程度方面产生了相互矛盾的发现.
- 十一项关于安全性的研究报告了可变的感染率 (0-22%) 和重新手术率 (0-29%).
- 一项经济评估表明,在6个月的时间内,SNM与保守治疗相比没有成本效益.
结论:
- 目前关于SNM对儿童和成人耐火性异常性STC的有效性和成本效益的证据是不确定的.
- 显著的重新运行率高达29%,需要仔细考虑SNM的安全性.
- 局限性包括少数研究和研究设计和患者群体的相当多样性.
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