成年人急性尾炎的抗生素治疗与尾切除:个体患者数据的元分析
Jochem C G Scheijmans1, Jussi Haijanen2, David R Flum3
1Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands.
The lancet. Gastroenterology & hepatology
|January 19, 2025
概括
抗生素是急性尾炎尾切除术的安全替代品,使许多人能够避免手术. 然而,抗生素治疗增加了尾炎患者的并发症,大约一半需要在一年内进行手术.
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:
- 随机对照试验 (RCT) 表明,抗生素是急性尾炎尾切除术的可行且安全的替代方案.
- 在RCT中,患者纳入标准和结果定义存在显著的变化.
- 这项研究解决了在比较抗生素治疗与尾切除时需要统一的结果定义的需求.
研究的目的:
- 为了比较抗生素治疗的疗效和安全性与急性尾炎的尾切除术.
- 利用来自RCT的个体患者数据进行可靠的元分析.
- 应用统一的结局定义,包括1年随访后的并发症率和尾切除率.
主要方法:
- 单个患者的数据 RCT 的元分析比较抗生素和尾切除在成人急性尾炎.
- 在PubMed,Embase和Cochrane注册表中搜索到2023年6月6日.
- 使用克拉维恩-丁多分类统一的并发症数据;分析结果按尾炎的存在分层.
主要成果:
- 分析了涉及2101名患者的6项RCT的数据.
- 一年后的整体并发症率为抗生素的5.4%,尾切除术的8.3% (OR 0.49;95% CI 0.20-1.20).
- 在尾炎患者中,抗生素治疗导致更高的并发症率 (15.0%对6.3%) 和更高的随后尾切除率 (48.7%对30.6%).
结论:
- 抗生素治疗是急性尾炎手术的安全替代方案,使得相当一部分患者能够避免尾切除.
- 对于尾炎患者来说,初始抗生素治疗与并发症增加有关,并且在一年内需要尾切除的可能性更高.
- 结果支持共享决策,特别是考虑到附录的存在或不存在.
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