对穿孔性胃潰瘍疾病进行 laparoscopic 縫修复:一个元综述和试验序列分析
S I Panin1, T V Nechay2, I V Sazhin2
1Volgograd State Medical University, Volgograd, Russia.
Frontiers in surgery
|February 27, 2025
概括
穿孔性胃潰瘍的 laparoscopic 縫合修復大大降低了手術後的疼痛. 然而,试验的顺序分析表明,没有足够的证据来支持对手术时间,住院时间或死亡率等其他重大并发症的益处.
科学领域:
- 手术创新 在外科创新.
- 证据综合 证据综合
- 胃肠道手术 胃肠道手术
背景情况:
- 手术系统审查 (SRs) 的数量正在迅速增加.
- 超流行病学提供了一种方法来合成来自多个重叠的SRs的数据.
- 在外科手术元分析中,评估证据多样性至关重要.
研究的目的:
- 综合来自随机对照试验 (RCT) 的SRs的证据,用于穿孔性胃潰瘍 (PPU) 的腹腔镜修复.
- 用试验顺序分析 (TSA) 来重新分析结果数据,以进行可靠的评估.
- 评估各种结果的证据的确定性.
主要方法:
- 在2024年6月之前通过搜索多个数据库 (Cochrane Library,PubMed,Embase,CINAHL,eLibrary,ClinicalTrials.gov) 进行了一项元流行病学研究.
- 确定并评估了16个SRs,包括三次重叠的RCT审查.
- 应用TSA重新分析聚合数据并评估多样性调整所需信息大小 (DARIS).
主要成果:
- 与开放修复相比,腹腔镜修复在24-72小时内显示了明显较低的术后疼痛得分,达到DARIS的100%.
- 对于手术时间 (DARIS 40.1%) 或住院时间 (DARIS 14.6%),TSA表示没有显著的益处或危害.
- 对于死亡率,手术部位感染和腹腔内,DARIS低于5%,这表明进一步的试验不太可能产生确的结果.
结论:
- 综合证据和TSA证实,腹腔镜 suture修复的PPU提供了显著减少术后疼痛.
- 目前的证据基础不足以证明对手术时间,住院时间或重大并发症的益处.
- 通过额外的研究来获得死亡率和感染等结果的确证据似乎不太有希望.
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