在随机对照试验中,结直肠内镜下粘膜剖析后的预防性剪切:系统性审查和元分析
Ludovico Alfarone1, Marco Spadaccini1, Tommy Rizkala1
1Department of Gastroenterology and Endoscopy, IRCCS Humanitas Research Hospital, Rozzano, Italy.
Endoscopy
|February 27, 2026
概括
在结肠直肠内镜下粘膜解剖 (ESD) 后预防性剪切显著降低了延迟出血的风险. 这一元分析支持其常规使用,以改善手术后的患者安全.
科学领域:
- 胃肠病学和内镜检查
- 手术瘤学手术瘤学
- 临床试验方法论 临床试验方法论
背景情况:
- 内镜下粘膜切割 (ESD) 是大结直肠多的一个关键技术.
- 像延迟出血,穿孔 (PPP) 和后凝血综合征 (PECS) 这样的不良事件 (AE) 是显著的风险.
- 在结直肠ESD后预防性缺陷关闭的好处尚未得到充分证实.
研究的目的:
- 评估预防性剪切在结直肠ESD后减少AE的有效性.
- 评估预防性剪切对延迟出血,PPP和PECS的影响.
主要方法:
- 按照PRISMA指南进行随机对照试验 (RCT) 的系统元分析.
- 搜索了MEDLINE,Embase和SCOPUS的RCT,比较预防性剪切与没有剪切后结直肠ESD.
- 分析了4项涉及684名成年患者的RCT的数据,使用随机效应模型.
主要成果:
- 预防性剪切显著减少了临床显著的延迟出血 (0.3%对3.4%;RR 0.26).
- 在术后穿孔 (PPP) 或后电凝综合征 (PECS) 发生率上没有发现显著差异.
- 根据病变大小和位置对子组的分析没有产生显著的发现.
结论:
- 结直肠ESD后的预防性剪切导致延迟出血风险大幅减少74%.
- 这些发现支持在临床实践中定期采用预防性剪切.
- 进一步的研究可能会探索针对特定损伤特征的最佳技术.
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