重新评估儿科无并发性急性尾炎的非手术治疗:系统性审查和元分析
Isabella Faria1, Ana Carolina Godinho Cintra2, Luiz Gustavo Albuquerque Mello de Oliveira2
1Department of Surgery, University of Texas Medical Branch, Galveston.
JAMA pediatrics
|October 5, 2025
概括
与尾切除术相比,小儿尾炎的非手术治疗 (NOM) 在一年内显示出更高的失败和并发症率. 这一元分析提供了关键的数据,用于就治疗耐用性和安全性做出明智的临床决策.
科学领域:
- 儿科手术 儿科手术
- 胃肠病学 胃肠病学
- 临床试验 临床试验
背景情况:
- 非手术治疗 (NOM) 是儿童急性无并发性尾炎的手术替代方案.
- 人们对NOM的耐用性,并发症率和长期失效存在担忧.
- 需要对随机临床试验 (RCT) 进行更新的元分析,以澄清NOM与尾切除的结果.
研究的目的:
- 评估NOM的安全性和有效性与儿童无并发性尾炎的尾切除相比.
- 为了进行比较,使用最高水平的可用证据 (RCT).
主要方法:
- 随机试验的系统综述和分析,比较儿科患者 (<18岁) 的NOM与外科治疗.
- 在2025年3月之前搜索了PubMed,Embase,Scopus,Cochrane和科学网.
- 根据PRISMA指南提取数据;进行随机效应元分析;评估偏差风险;进行试验顺序分析.
主要成果:
- 包括七个RCT (1480名患者).
- 一年后,NOM的治疗失败率显著高 (RR 4.97) 和成功率较低 (RR 0.67).
- 主要并发症 (Clavien-Dindo ≥IIIb) 在NOM中更频繁 (RR 33.37);尾炎复发率在NOM中为18.47%.
- NOM显示返回学校/活动的速度更快,但这可能会被重新干预所抵消.
结论:
- 这项元分析发现,与尾切除术相比,儿童的NOM在一年内治疗失败率和重大并发症率显著更高.
- 结果与早期的研究形成鲜明对比,强调需要更新证据.
- 为儿科医生和外科医生提供关键数据,以告知与家庭共享决策,以实现个性化,以患者为中心的治疗.
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