inguinal hernia 的手术与保守管理:对随机对照试验的方法范围审查
Maria Picciochi1, Matthew J Lee2, Samir Pathak3
1NIHR Global Surgery Unit, University of Birmingham, Birmingham, UK.
BJS open
|September 24, 2024
概括
对最小症状的 inguinal hernias 的治疗缺乏共识. 随机临床试验 (RCT) 的系统审查发现偏差很高,但概括性很好,表明需要更强大的数据来改进患者护理指南.
科学领域:
- 一般外科 整体外科
- 临床试验方法论 临床试验方法论
- 基于证据的医学基于证据的医学.
背景情况:
- 在管理有限症状的 inguinal hernias 方面缺乏共识.
- 对随机临床试验 (RCT) 进行了系统审查,以评估现有关于无症状管理的数据.
- 专注于这些RCT的研究结果的概括性.
研究的目的:
- 系统地审查和批判性地评估所有现有的随机临床试验 (RCT) 关于无症状和最小症状的 inguinal 的管理.
- 评估已确定RCT的质量和通用性.
- 为这个患者群体提供改进的临床指导方针.
主要方法:
- 使用范围审查方法来确定相关的RCT.
- 在Medline,Embase,Cochrane和ClinicalTrials.gov.gov网站进行了搜索.
- 研究特征,人群/干预/比较/结果,局限性,偏差风险 (Cochrane ROB-2) 和概括性 (PRECIS-2) 被提取和评估.
主要成果:
- 搜索产生了661篇论文,最终包括三个RCT用于分析.
- 所有包含的RCT都集中在55岁以上的男性患者身上,患者有无症状或最小症状的.
- 在所有RCT中都注意到存在偏差的高风险;根据PRECIS-2,两个被归类为务实性,一个被归类为同样务实性/解释性.
- 观察到"最小症状"和"保守治疗"的不同定义,以及不同的随访期 (1-3年).
结论:
- 系统性审查发现,在现有RCT中存在高偏差风险,用于最小症状的 inguinal hernias.
- 尽管存在偏见,但这些RCT的研究结果的概括性被认为是好的.
- 进一步的高质量,可概括的数据对于完善临床管理指南对于患有最小症状的 inguinal hernias 的患者至关重要.
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