经皮导管引流与经皮穿刺抽吸治疗肝脓肿的疗效比较：系统评价、荟萃分析和试验序贯分析。
Percutaneous catheter drainage versus percutaneous needle aspiration for liver abscess: a systematic review, meta-analysis and trial sequential analysis.
机构信息
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
出版信息
BMJ Open. 2023 Jul 30;13(7):e072736. doi: 10.1136/bmjopen-2023-072736.
OBJECTIVE
To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.
DESIGN
Systematic review, meta-analysis and trial sequential analysis.
DATA SOURCES
PubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022.
ELIGIBILITY CRITERIA
Randomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language.
DATA EXTRACTION AND SYNTHESIS
Primary outcome was treatment success rate. Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.
RESULTS
Ten trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p<0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) -2.53 days; 95% CI -3.54 to -1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD -2.49 days; 95% CI -3.59 to -1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD -4.04 days, 95% CI -5.99 to -2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.
CONCLUSION
In patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.
PROSPERO REGISTRATION NUMBER
CRD42022316540.
目的
比较经皮导管引流（PCD）与经皮穿刺抽吸（PNA）治疗肝脓肿的疗效和安全性。
设计
系统评价、荟萃分析和试验序贯分析。
数据来源
从建库到 2022 年 3 月 16 日，检索 PubMed、Web of Science、Cochrane 图书馆、Embase、Airiti 图书馆和 ClinicalTrials.gov 数据库。
纳入标准
比较 PCD 与 PNA 治疗肝脓肿的随机对照试验均纳入，语言不受限制。
数据提取与合成
主要结局为治疗成功率。根据异质性，使用固定效应模型或随机效应模型得出总体估计值。使用 Review Manager V.5.3 软件进行荟萃分析。使用试验序贯分析软件进行试验序贯分析。使用 Grading of Recommendations, Assessment, Development and Evaluation 系统评估证据确定性。
结果
纳入 10 项共 1287 人的试验。汇总分析显示，与 PNA 相比，PCD 提高了治疗成功率（风险比 1.16，95%置信区间 1.07 至 1.25）。试验序贯分析证实了这一稳健的发现，并达到了所需的信息量。对于大脓肿，亚组分析支持 PCD（组间差异检验，p<0.001）。与 PNA 相比，汇总分析表明 PCD 在达到临床改善或完全临床缓解的时间（6 项研究共 1000 例患者的平均差异（MD）-2.53 天；95%置信区间-3.54 至-1.52）、脓肿体积缩小 50%的时间（5 项研究共 772 例患者的 MD-2.49 天；95%置信区间-3.59 至-1.38）和静脉用抗生素使用时间（4 项研究共 763 例患者的 MD-4.04 天；95%置信区间-5.99 至-2.10）方面有显著获益。住院死亡率和并发症无差异。
结论
在肝脓肿患者中，超声引导下 PCD 使每 1000 例患者的治疗成功率提高 136 例，改善临床结局 3 天，并减少静脉用抗生素 4 天。
PROSPERO 注册号：CRD42022316540。
Zotero 插件