Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis.
Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2014-006063
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发表时间：
2015-03-24
期刊：
影响因子：
2.9
通讯作者：
Knight M
中科院分区：
文献类型：
--
作者：
Thomson D;Allin B;Long AM;Bradnock T;Walker G;Knight M
比较对于患有无并发症先天性巨结肠的婴儿，完全经肛门直肠内拉出术 (TTERPT) 与任何形式的腹腔镜辅助拉出术 (LAPT) 后的结果。系统回顾和荟萃分析。五家提供儿科外科服务的医院。 405 名患有无并发症先天性巨结肠的婴儿。 TTERPT 与 LAPT。主要结局：死亡率、术后小肠结肠炎、大便失禁、便秘、计划外剖腹手术或造口形成以及腹部内脏损伤。需要输注血液制品的出血、脓肿形成、肠梗阻、肠缺血、肠瘘形成、尿失禁或尿潴留、阳痿和手术持续时间。从 2107 项研究中确定了五项符合条件的研究，涉及 405 名患者。所有研究都是回顾性病例系列，结果评估质量和随访时间长短存在差异。 TTERPT 的手术时间缩短了 50.29 分钟（95% CI 39.83 至 60.74，p<0.00001）。 TTERPT 和 LAPT 术后小肠结肠炎（OR=0.78，95% CI 0.44 - 1.38，p=0.39）、大便失禁（OR=0.44，95% CI 0.09 - 2.20，p=0.32）或便秘（OR=0.84，95% CI 0.32 - 2.17，p=0.71）。这项荟萃分析没有发现任何证据表明 TTERPT 后的小肠结肠炎、失禁或便秘发生率高于 LAPT。需要进一步的长期比较研究和多中心数据池来确定单纯经肛门方法是否比腹腔镜辅助方法在治疗直肠乙状结肠先天性巨结肠方面具有任何优势。 PROSPERO 注册表 - CRD42013005698。
To compare outcomes following totally transanal endorectal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) for infants with uncomplicated Hirschsprung's disease. Systematic review and meta-analysis. Five hospitals with a paediatric surgical service. 405 infants with uncomplicated Hirschsprung's disease. TTERPT versus LAPT. Primary outcomes: mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera. Haemorrhage requiring transfusion of blood products, abscess formation, intestinal obstruction, intestinal ischaemia, enteric fistula formation, urinary incontinence or retention, impotency and duration of procedure. Five eligible studies comprising 405 patients were identified from 2107 studies. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. Operative duration was 50.29 min shorter with TTERPT (95% CI 39.83 to 60.74, p<0.00001). There were no significant differences identified between TTERPT and LAPT for incidence of postoperative enterocolitis (OR=0.78, 95% CI 0.44 to 1.38, p=0.39), faecal incontinence (OR=0.44, 95% CI 0.09 to 2.20, p=0.32) or constipation (OR=0.84, 95% CI 0.32 to 2.17, p=0.71). This meta-analysis did not find any evidence to suggest a higher rate of enterocolitis, incontinence or constipation following TTERPT compared with LAPT. Further long-term comparative studies and multicentre data pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically assisted approach to rectosigmoid Hirschsprung's disease. PROSPERO registry- CRD42013005698.
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影响因子：
2.4
作者：
Owen, Anthony;Marven, Sean;Knight, Marian
通讯作者：
Knight, Marian
影响因子：
2.4
作者：
Marquez, Thao T.;Acton, Robert D.;Saltzman, Daniel A.
通讯作者：
Saltzman, Daniel A.
影响因子：
5.2
作者：
SOAVE, F
通讯作者：
SOAVE, F
影响因子：
2.4
作者：
De la Torre-Mondragón, L;Ortega-Salgado, JA
通讯作者：
Ortega-Salgado, JA
DOI：
10.1007/s004649901149
发表时间：
1999-10-01
期刊：
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
影响因子：
--
作者：
de Lagausie, P;Berrebi, D;Aigrain, Y
通讯作者：
Aigrain, Y