Đánh giá hệ thống và phân tích tổng hợp về kết quả hậu phẫu trong phẫu thuật cắt ruột khẩn cấp và tự chọn ở bệnh nhân mắc bệnh Crohn

International Journal of Colorectal Disease - Tập 36 - Trang 253-263 - 2020
Linnea Samsø Udholm1, Simon Ladefoged Rasmussen1, Thyge K. Madsbøll1, Mohammed Omairi2, Alaa El-Hussuna1
1Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
2Department of Emergency, Sydvestjysk Sygehus, Esbjerg, Denmark

Tóm tắt

Nghiên cứu đã xem xét liệu tính cấp bách của can thiệp phẫu thuật có ảnh hưởng đến kết quả postoperative ở bệnh nhân mắc bệnh Crohn (CD) đang trải qua phẫu thuật cắt ruột hay không. Việc đánh giá được thực hiện theo một giao thức nghiên cứu đã được công bố trước đó trong Prospero, một cơ sở dữ liệu quốc tế về các đánh giá hệ thống đăng ký trước trong lĩnh vực sức khỏe. Nghiên cứu báo cáo theo hướng dẫn PRISMA. Chúng tôi đã tìm kiếm trên Embase và Pubmed các bài báo báo cáo kết quả hậu phẫu sau phẫu thuật cấp cứu và phẫu thuật tự chọn ở bệnh nhân mắc CD đang trải qua phẫu thuật cắt ruột. Biến đầu ra chính là biến biến chứng tổng thể hậu phẫu trong 30 ngày, trong khi các biến đầu ra thứ cấp bao gồm các biến chứng nhiễm khuẩn trong ổ bụng (IASC), tỷ lệ tử vong, phẫu thuật lại và tái nhập viện. Đánh giá độ thiên lệch được thực hiện bằng cách sử dụng điểm Newcastle-Ottawa. Hai tác giả đã độc lập khai thác dữ liệu từ mỗi nghiên cứu, bệnh nhân và các biện pháp kết quả. Tìm kiếm đã xác định 22 nghiên cứu trong đó 955 bệnh nhân đã trải qua phẫu thuật khẩn cấp trong khi 6518 bệnh nhân đã trải qua phẫu thuật tự chọn. Dựa trên đánh giá chất lượng, 19 nghiên cứu được phân loại là có nguy cơ thiên lệch cao, một nghiên cứu có nguy cơ thiên lệch trung bình và 2 nghiên cứu có nguy cơ thiên lệch thấp (≥ 8 sao). Phân tích tổng hợp hiệu ứng ngẫu nhiên cho thấy phẫu thuật khẩn cấp có liên quan đến việc tăng ~ 40% biến chứng tổng thể so với phẫu thuật tự chọn (RR = 1.43, 95% CI [1.09; 1.87], p = 0.010). Các IASC cũng tăng lên ở những bệnh nhân đã phẫu thuật khẩn cấp (RR = 1.44, 95% CI [1.08; 1.92], p = 0.013). Không có sự khác biệt đáng kể nào được cho thấy ở tỷ lệ tử vong và tái nhập viện. Phẫu thuật cắt ruột khẩn cấp ở bệnh nhân mắc CD liên quan đến nguy cơ cao hơn về biến chứng tổng thể hậu phẫu và IASC.

Từ khóa

#Crohn’s disease #bowel resection #postoperative outcomes #urgent surgery #elective surgery #systematic review #meta-analysis

Tài liệu tham khảo

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