成年人穿孔性椎炎的保守管理:对结果的更新系统审查
Abdaal Munir1, Jamal Montaser2, Srihas Tumu2
1Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
ANZ journal of surgery
|February 17, 2026
概括
非手术治疗对于稳定的穿孔性分泌体炎 (PD) 患者来说是安全的,特别是含有空气的患者. 遥远的外空气预测了故障,需要对这些高风险病例进行密切监测或早期干预.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 医疗成像医学成像
背景情况:
- 穿孔性垂炎 (PD) 的管理已经转向稳定患者的非手术策略.
- 关于非手术治疗PD的安全性与外气 (Hinchey Ia-II) 进行了辩论.
- 本综述评估了PD非手术治疗的有效性,安全性和长期结果.
研究的目的:
- 评估穿孔性分泌体炎 (PD) 的非手术治疗的有效性和安全性.
- 确定PD治疗失败的放射学预测因素.
- 评估非手术性PD治疗的长期结果,包括复发和死亡率.
主要方法:
- 按照PRISMA 2020指南进行系统审查.
- 在多个数据库中进行了搜索 (PubMed/MEDLINE,Cochrane等). 对于队列研究 (2015-2025年).
- 包括CT确认的PD (Hinchey I-II) 的成年人进行非手术治疗;评估治疗成功,复发,再录取和死亡率.
主要成果:
- 十二项队列研究 (25,064名患者) 显示,封闭性穿孔的成功率为76%-96%.
- 遥远的外气 (DA) 显著预测失效 (10% - 37%的成功率与>85%的外气相比).
- 其他故障预测因素:>4厘米,自由液体,年龄>75. 随着时间的推移,死亡率下降;复发率为16.5%-37.5%.
结论:
- 非手术治疗是稳定的PD患者的安全有效的第一线治疗方法,特别是在隔离的风空气中.
- 患有遥远的外气或大的患者面临更高的失败风险.
- 密切监测或早期干预对于非手术治疗的高风险PD患者至关重要.
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