消化管的解剖学泄漏的管理,一个系统的审查和网络元分析
William Murray1, Mathew G Davey1, William Robb1
1Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin, Ireland.
概括
内镜真空辅助关闭 (EVAC) 对于食道动脉泄漏是有效的,比支架更低的并发症和死亡率. 对于较大的泄漏,重新操作是最好的.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 医疗器械技术 医疗器械技术
背景情况:
- 消化道的解漏洞缺乏一个共识的管理策略.
- 目前的选择包括内镜真空辅助关闭 (EVAC),支架,重新操作和保守的管理.
研究的目的:
- 系统地审查和执行网络元分析 (NMA).
- 评估最佳的管理策略,以食道解性泄漏.
主要方法:
- 按照PRISMA指导方针进行系统审查,并扩展NMA.
- 分析了12项涉及511名患者的回顾性研究.
- 使用R包和Shiny进行的NMA.
主要成果:
- 与支架相比,内镜真空辅助关闭 (EVAC) 显示出明显较低的并发症率 (OR 0.23) 和死亡率 (OR 0.43).
- 对于比支架更大的漏洞 (MD 14.66) 用了重新操作.
- 作为一线干预措施,EVAC显示出有效性.
结论:
- 内镜真空辅助关闭 (EVAC) 是对食道漏的高效一线治疗方法,可以减少并发症和死亡率.
- 对于具有全身特征的显著较大或未被控制的泄漏,手术管理仍然至关重要.
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