Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis.
Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis.
复制标题
新生儿先天性膈疝的手术方法：系统评价和荟萃分析。
DOI：
10.1007/s00383-015-3765-1
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发表时间：
2015
期刊：
影响因子：
1.8
通讯作者：
Usui N.
中科院分区：
文献类型：
--
作者：
Terui K;Nagata K;Ito M;Yamoto M;Shiraishi M;Taguchi T;Hayakawa M;Okuyama H;Yoshida H;Masumoto K;Kanamori Y;Goishi K;Urushihara N;Kawataki M;Inamura N;Kimura O;Okazaki T;Toyoshima K;Usui N.
目的探讨新生儿先天性腹股沟疝（CDH）的最佳手术入路。我们进行了系统的回顾和荟萃分析的有效性，内镜手术（ES）新生儿CDH.MethodsA系统的文献检索使用MEDLINE和科克伦图书馆。选择比较新生儿CDH手术方法的研究。死亡率和疝复发率作为主要终点进行分析。每项研究进行了评估后的分级建议评估，发展和评价（GRADE）system.ResultsEight观察性研究比较ES和开放手术（OS）符合标准。与OS组相比，ES组的死亡率显著降低[危险比（RR）0.18，95%CI 0.09- 0.38，p < 0.0001]，复发率显著升高[RR 3.10，95%CI 1.95- 4.88，p < 0.00001]。然而，严重的选择偏差被认为是在七个八项研究，因为适应症的ES已被确定故意，ES组可能包括不太严重的cases.ConclusionAlthough证据不足，ES是明确与更多的复发比OS。因此，ES不应该是每一个新生儿的常规治疗。选择合适的病例进行ES至关重要。
PurposeThe optimal surgical approach for neonatal congenital diaphragmatic hernia (CDH) remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of endoscopic surgery (ES) for neonatal CDH.MethodsA systematic literature search was conducted using MEDLINE and the Cochrane Library. Studies that compared surgical approaches for neonatal CDH were selected. Mortality and recurrence of herniation were analyzed as primary endpoints. Each study was evaluated following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.ResultsEight observational studies comparing ES and open surgery (OS) met the criteria. As compared with the OS group, the ES group showed both a significantly lower mortality rate [risk ratio (RR) 0.18, 95 % confidence interval (CI) 0.09–0.38,p< 0.0001] and a significantly higher recurrence rate (RR 3.10, 95 % CI 1.95–4.88,p< 0.00001). However, serious selection bias was seen in seven of the eight studies—because the indication of ES had been determined intentionally, the ES groups may have included less severe cases.ConclusionAlthough the evidence was insufficient, ES was clearly associated with more recurrence than was OS. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES.