抗生素治疗可以替代小儿急性无并发尾炎的手术吗? 随机对照试验的更新元分析
Kai Lu1, Shilong Shu1, Junwei Wang2
1Department of General Surgery, Zigong Fourth People's Hospital, 643000, No. 400, Dangui Avenue, Ziliujing District, Zigong, Sichuan Province, China.
Journal of pediatric surgery
|August 20, 2025
概括
儿童无并发性尾炎的非手术治疗 (NOM) 的失败率高于手术治疗 (OM). 在经过仔细评估后,建议使用OM作为主要治疗方法.
科学领域:
- 儿童手术
- 胃肠病学
- 临床试验
背景情况:
- 儿童无并发性尾炎的非手术治疗 (NOM) 缺乏大型随机对照试验 (RCT) 的强有力的证据.
- 对于儿科UA的NOM与手术治疗 (OM) 的有效性和安全性仍在争论中.
- 本次元分析通过综合更新的RCT数据来解决这一争议.
研究的目的:
- 评估儿童无并发性尾炎的非手术治疗 (NOM) 的有效性.
- 为了比较NOM和OM之间的治疗失败率,生活质量和成本.
- 为儿童UA管理提供基于证据的建议.
主要方法:
- 在2025年4月18日之前对主要数据库 (Web of Science,Embase,Cochrane,PubMed) 进行系统的文献搜索.
- 包括对儿科UA的NOM与OM进行比较的RCT
- 使用RevMan 5. 3进行的元分析,重点关注初始,退院1年后的治疗失败率.
主要成果:
- 分析了5个涉及1423名患者的RCT (NOM: 738; OM: 685).
- 与OM相比,NOM的初始治疗失败率 (OR: 3. 14),退院后的一年 (OR: 20. 53) 和整体治疗失败率 (OR: 8. 47) 显著提高.
- 尽管缺课日数减少,但NOM与更多的不良事件,更长的住院时间和更多的再入院病例有关.
结论:
- 更新的大规模RCT表明,非手术治疗 (NOM) 比手术治疗 (OM) 在儿科无并发性尾炎 (UA) 中效果较差.
- 操作性管理 (OM) 仍然是主要的治疗策略.
- 对于特定的儿科UA病例,可能会考虑NOM,这取决于彻底的风险-益处评估.
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