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症状,无症状和复发性缺口的管理:系统性审查和元分析
Nader M Hanna1, Sunjay S Kumar2, Amelia T Collings3
1Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. nader.hanna@queensu.ca.
Surgical endoscopy
|April 17, 2024
概括
缺口的手术治疗是有争议的. 网格修复可能会降低复发率,但增加消化不良; fundoplication 减少反流,但提高消化不良. 共享决策是关键的.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 基于证据的医学基于证据的医学.
背景情况:
- 对椎间的最佳手术方法进行了辩论,使用不同的技术和结果.
- 这项研究比较了网状与无网状,基底复合与无基底复合,手术与观察,重复修复与Roux-en-Y重建.
研究的目的:
- 为了比较有网状与没有网状的结局,以及在症状性椎间盘中 fundoplication 与 no fundoplication 的结局.
- 为了评估手术与无症状椎间的观察.
- 评估重复 Hernia 修复与转换到 Roux-en-Y 重建的复发性间歇性.
主要方法:
- 从2000年到2022年,主要数据库 (PubMed,Embase,CINAHL,Cochrane Library,ClinicalTrials.gov) 进行了系统的文献搜索.
- 包括随机对照试验 (RCT),观察性研究和病例系列,由两个独立审查员进行查.
- 对比数据进行了聚合分析,并使用既有工具评估了偏差风险.
主要成果:
- 网格的使用在观察性研究中显示出较低的复发率,但不是RCT,并且在观察数据中与较高的早期失足症有关.
- 基金复合与早期失消症的增加有关,但在RCT中减少了反流.
- 转换为Roux-en-Y重建表明,与重复的重复手术相比,重新干预的风险较低;没有研究将手术与无症状病例的观察相比较.
结论:
- 目前对椎间板管理的证据受到研究偏差的限制,这突显了需要高质量的研究的需要.
- 外科医生和患者之间的共享决策对于优化间修复结果至关重要.
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