Tập trung vào rectopexy bụng để điều trị sa trực tràng toàn phần: tổng hợp phân tích văn liệu

Techniques in Coloproctology - Tập 16 - Trang 37-53 - 2011
F. Cadeddu1, P. Sileri1, M. Grande1, E. De Luca1, L. Franceschilli1, G. Milito1
1Department of Surgery, University Hospital Tor Vergata, Rome, Italy

Tóm tắt

Rectopexy nội soi để điều trị sa trực tràng toàn phần đã chứng minh được lợi ích ngắn hạn, nhưng có rất ít dữ liệu theo dõi lâu dài và kết quả chức năng khả dụng. Sử dụng các kỹ thuật tổng hợp phân tích, nghiên cứu này được thiết kế để đánh giá các kết quả lâu dài của các phương pháp phẫu thuật bụng mở và nội soi để điều trị sa trực tràng toàn phần ở người trưởng thành. Một cuộc tổng quan tài liệu đã được thực hiện sử dụng cơ sở dữ liệu PubMed của Thư viện Y khoa Quốc gia. Tất cả các bài báo về bệnh nhân rectopexy bụng với thời gian theo dõi dài hơn 16 tháng đã được xem xét. Chỉ số chính là tỷ lệ tái phát của chứng sa trực tràng, và các chỉ số thứ yếu là sự cải thiện của chứng incontinence và táo bón. Một mô hình hiệu ứng ngẫu nhiên đã được sử dụng để tổng hợp các nghiên cứu báo cáo những kết quả này, và độ đồng nhất đã được đánh giá. Tám nghiên cứu so sánh, bao gồm tổng cộng 467 bệnh nhân (275 người phẫu thuật bụng mở và 192 người phẫu thuật nội soi), đã được đưa vào. Phân tích dữ liệu cho thấy không có sự khác biệt đáng kể về tỷ lệ tái phát, sự cải thiện incontinence và táo bón giữa rectopexy bụng nội soi và rectopexy bụng mở. Xét về các thử nghiệm không so sánh, tỷ lệ sự kiện tái phát tương tự trong các nghiên cứu rectopexy chỉ khâu mở và nội soi cũng như trong các thử nghiệm rectopexy lưới mở và nội soi. Sự cải thiện tình trạng táo bón sau can thiệp không có ý nghĩa thống kê, ngoại trừ trường hợp sửa chữa lưới mở; sự cải thiện sau phẫu thuật về chứng incontinence có ý nghĩa thống kê sau các thủ thuật nội soi và rectopexy lưới mở. Rectopexy bụng nội soi là một thủ thuật an toàn và khả thi, có thể so sánh tương đương với kỹ thuật mở về tỷ lệ tái phát, bệnh incontinence và táo bón. Tuy nhiên, vẫn cần các thử nghiệm ngẫu nhiên quy mô lớn, với phương pháp so sánh mạnh mẽ, để xác định chính xác các chỉ số kết quả.

Từ khóa

#rectopexy bụng #sa trực tràng #phẫu thuật nội soi #tái phát #incontinence #táo bón

Tài liệu tham khảo

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