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Kỹ thuật kéo qua trực tràng hay qua bụng cho bệnh Hirschsprung; cái nào tốt hơn? Một tổng quan hệ thống và phân tích tổng hợp
Tóm tắt
Các thắc mắc liên quan đến kết quả lâu dài của phương pháp kéo qua trực tràng hoặc qua bụng (TEPT) do việc kéo dài ống hậu môn kéo dài và các vấn đề dẫn đến co thắt và kiểm soát đại tiện đã bắt đầu bị nghi ngờ. Phân tích tổng hợp này nhằm so sánh kết quả lâu dài giữa TEPT và kỹ thuật kéo qua bụng (TAB) trong quản lý phẫu thuật bệnh Hirschsprung.
Tất cả các ấn phẩm từ năm 1998 đến 2021 trong các cơ sở dữ liệu PubMed, Medline, Google Scholar, Cochrane đã được xem xét. Các nghiên cứu so sánh hồi cứu và tiến cứu cho TEPT, TAB cũng như TEPT hỗ trợ nội soi (LTEPT) đã được bao gồm. Dữ liệu bao gồm tuổi lúc phẫu thuật, táo bón sau phẫu thuật, viêm ruột kết, không kiểm soát đại tiện, co thắt và tỷ lệ làm bẩn. Mười tám ấn phẩm đáp ứng tiêu chí bao gồm cho TAB và TEPT, và sáu cho TEPT và LTEPT. Bệnh nhân thực hiện TEPT có độ tuổi phẫu thuật trẻ hơn đáng kể so với bệnh nhân thực hiện TAB (SMD − 1.02, 95% Cl − 1.85 đến − 0.18, p: 0.0168). Tỷ lệ táo bón sau phẫu thuật (OR 0.39, 95% Cl 0.25–0.61 p < 0.0001) và viêm ruột kết (OR 0.65, 95% Cl 0.46–0.90, p: 0.0108) thấp hơn đáng kể ở nhóm TEPT. Tỷ lệ không kiểm soát đại tiện sau phẫu thuật (OR 1.06, 95% Cl 0.56–2.01, p: 0.8468), co thắt (OR 1.97, 95% Cl 0.81–4.80, p: 0.1352) và tỷ lệ làm bẩn tương đương giữa hai nhóm. Hơn nữa, khi so sánh kết quả TEPT và LTEPT, tỷ lệ không kiểm soát đại tiện (OR 7.01, 95% Cl 0.75–65.33, p: 0.0871), táo bón (OR 1.95, 95% Cl 0.70–5.37, p: 0.199), viêm ruột kết (OR 3.16, 95% Cl 0.34–29.55 p: 0.3137), co thắt (OR 1.33, 95% Cl 0.29–6.15, p: 0.7188) và làm bẩn (OR 1.57, 95% Cl 0.57–4.31, p: 0.3778) tương tự cho cả hai kỹ thuật. TEPT vượt trội hơn TAB về mặt táo bón và viêm ruột kết. Ngược lại với mối quan ngại, tỷ lệ không kiểm soát đại tiện sau phẫu thuật không khác biệt về mặt thống kê. Tuy nhiên, cần có thêm các ấn phẩm về kết quả lâu dài của LTEPT để có kết luận đáng tin cậy hơn.
Từ khóa
#TEPT #TAB #LTEPT #bệnh Hirschsprung #táo bón #viêm ruột kết #không kiểm soát đại tiện #phân tích tổng hợpTài liệu tham khảo
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