Elisabeth Wadewitz, Juliane Friedrichs, Maurizio Grilli, Johannes A Vey, Samuel Zimmermann, Yoshiaki Sunami, Jörg Kleeff, Ulrich Ronellenfitsch, Johannes Klose, Artur Rebelo
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引用次数: 0
摘要
目的：本网络荟萃分析（NMA）旨在评估手术和替代治疗策略对穿孔性消化性溃疡（PPU）的死亡率和其他临床相关结局的影响。方法：按照PRISMA指南进行NMA评估PPU的治疗方法。通过系统检索PubMed/MEDLINE、Cochrane Library、Embase、CINAHL、ClinicalTrials.gov和ICTRP数据库确定随机对照试验（RCT）。使用连续数据的标准化平均差异（SMDs）和二元数据的优势比（ORs）对结果进行分析，两者在网络荟萃分析框架中均以95%置信区间（CI）表示。结果：该NMA纳入了16项研究，包括1,259例患者。腹腔镜入路明显降低了死亡率（OR 0.36, 95% CI 0.17-0.75, p = 0.0065）和术后并发症，包括伤口感染（OR 0.15, 95% CI 0.08-0.27, p）。结论：该NMA，特别是两两分析，证实了腹腔镜手术比开放手术的显著优势，巩固了其作为PPU金标准的地位。由于证据不足，替代方法的潜在益处尚无定论。
Approaches for the treatment of perforated peptic ulcers: a network meta-analysis of randomized controlled trials.
Purpose: This network meta-analysis (NMA) aims to evaluate surgical and alternative treatment strategies for perforated peptic ulcers (PPU) with respect to mortality and other clinically relevant outcomes.
Methods: An NMA was conducted in accordance with PRISMA guidelines to assess treatment approaches for PPU. Randomized controlled trials (RCT) were identified through systematic searches of PubMed/MEDLINE, Cochrane Library, Embase, CINAHL, ClinicalTrials.gov, and ICTRP databases. Outcomes were analyzed using standardized mean differences (SMDs) for continuous data and odds ratios (ORs) for binary data, both presented with 95% confidence intervals (CI) in a network meta-analysis framework.
Results: Sixteen studies comprising 1,259 patients were included in this NMA. The laparoscopic approach demonstrated significantly reduced mortality (OR 0.36, 95% CI 0.17-0.75, p = 0.0065) and postoperative complications, including wound infections (OR 0.15, 95% CI 0.08-0.27, p < 0.0001) and ileus (OR 0.33, 95% CI 0.18-0.59), compared to the open surgical approach.
Conclusions: This NMA, particularly the pairwise analysis, confirms the significant advantages of laparoscopic over open surgery, reinforcing its status as the gold standard for PPU. The potential benefits of alternative approaches, are inconclusive due to insufficient evidence.
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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