Leilei Zhu, Jingyi Shen, Rongrong Fu, Xiaozhen Lu, Liwen Du, Ruihao Jiang, Mengting Zhang, Yetan Shi, Ke Jiang, Yongwei Shi
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引用次数: 0
摘要
背景:目前，在急性坏死性胰腺炎(ANP)中，微创介入治疗(MII)已在很大程度上取代了延迟开放手术。然而，信息产业部的上市时间仍不明朗。本研究探讨了早期与延迟MII对ANP并发症的影响。方法:全面检索PubMed、Embase、Cochrane Library和Web of Science自成立至2022年6月期间评估MII时机对ANP患者并发症影响的研究。研究的主要结局是死亡率。次要结局是并发症的发生率。结果:9项研究报告了870例因ANP接受MII治疗的患者。早期干预组和延迟干预组的死亡率没有显著差异。此外，MII的时间与新发呼吸衰竭、新发心血管衰竭、新发肾功能衰竭、新发多器官功能衰竭、胃肠道瘘或穿孔、胰瘘、支架移位、出血、静脉血栓形成、新发胰腺内分泌功能不全的发生率无关。值得注意的是，在胆道和亚洲ANP患者的亚组分析中，早期干预与新发肾衰竭的风险显著高于延迟干预。结论:早期干预是安全的，建议仅对有指征的患者进行干预，如感染。
Early versus Delayed Minimally Invasive Intervention for Acute Necrotizing Pancreatitis: An Updated Systematic Review and Meta-Analysis.
Background: Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP.
Methods: Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications.
Results: Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention.
Conclusions: Early intervention is safe and recommended only for patients with indications for intervention, such as infection.
期刊介绍：
''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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