Zhou Weimo, Shi Yingzuo, Zhang Ming, Li Li
Department of Pediatric Surgery, Guigang City People's Hospital, Eighth Affiliated Hospital of Guangxi Medical University, Guigang, China.
Department of Pediatric Surgery, Wuxi People's Hospital, Wuxi, China.
Front Surg. 2022 Feb 24;9:835235. doi: 10.3389/fsurg.2022.835235. eCollection 2022.
Pediatric rectal prolapse is a common issue in clinical practice. Among various managements, sclerotherapy is an important method to successfully treat pediatric rectal prolapse, especially for the first injection. The knowledge of the first injection of sclerotherapy can be revealed by a systemic review and meta-analysis of randomized clinical trials.
We performed a systematic search and a meta-analysis for the retrospective clinical studies of sclerotherapy in pediatric rectal prolapse. The comparison between remission and recurrence after the first injection of sclerotherapy was performed to find if the first injection of sclerotherapy can treat rectal prolapse completely. After a restricted selection, 17 studies involving 1,091 pediatric rectal prolapse subjects with sclerotherapy were enrolled in a variety of classifications of injection agents. The focused outcome was to check whether the first injection of sclerotherapy can achieve a remission status. The meta-analysis was performed by Review Manager 5.4.
Among the subjects receiving sclerotherapy, the meta-analysis favors the remission status after receiving the first injection of sclerotherapy. The meta-analysis results showed significant remission tests for the overall effect and significant heterogeneities in odds ratio and the fixed-effects model. The significant therapeutic effects remained, however, even after testing in the relative risk and the random-effects model.
Despite significant heterogeneity and relatively low quality of evidence, the first injection of sclerotherapy may conceivably demonstrate therapeutic effects to help the patients of pediatric rectal prolapse achieve a remission status.
小儿直肠脱垂是临床实践中的常见问题。在各种治疗方法中，硬化疗法是成功治疗小儿直肠脱垂的重要方法，尤其是首次注射。通过对随机临床试验的系统评价和荟萃分析，可以揭示硬化疗法首次注射的相关知识。
我们对小儿直肠脱垂硬化疗法的回顾性临床研究进行了系统检索和荟萃分析。比较硬化疗法首次注射后的缓解与复发情况，以确定首次注射硬化疗法能否完全治疗直肠脱垂。经过严格筛选，纳入了17项涉及1091例接受硬化疗法的小儿直肠脱垂患者的研究，这些研究采用了多种注射剂分类。重点观察的结果是检查硬化疗法首次注射是否能达到缓解状态。使用Review Manager 5.4进行荟萃分析。
在接受硬化疗法的受试者中，荟萃分析支持首次注射硬化疗法后的缓解状态。荟萃分析结果显示总体效应的缓解检验具有显著性，但比值比和固定效应模型存在显著异质性。然而，即使在相对风险和随机效应模型中进行检验，显著的治疗效果仍然存在。
尽管存在显著异质性且证据质量相对较低，但硬化疗法首次注射可能显示出治疗效果，有助于小儿直肠脱垂患者达到缓解状态。
