Di Buono Giuseppe, Romano Giorgio, Amato Giuseppe, Barletta Gabriele, Romano Giorgio, Adelfio Nicoletta, Geraci Girolamo, Agrusa Antonino
Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy.
J Clin Med. 2024 Aug 19;13(16):4894. doi: 10.3390/jcm13164894.
: Abdominal tuberculosis comprises all forms of tuberculosis that involve the gastrointestinal tract. Controversies exist regarding the surgical approach and timing and type of intervention for complicated forms of abdominal tuberculosis. The aim of this systematic review is to define the rate of surgical treatment, the type of surgical procedures performed and the role of minimally invasive surgery in the management of abdominal tuberculosis. : The literature in MEDLINE, Scopus and Google Scholar and forward and backward citations for studies published between database inception and July 2022 were searched without language restrictions. All prospective and retrospective studies were included. The electronic database search yielded 2440 records. Additionally, eight records were identified through snowball searching. Following duplicate removal (45 duplicates found), 2403 records were screened for titles and abstracts. After screening for titles and abstracts and exclusion criteria, 38 reports were included for systematic review, 27 retrospective studies and 11 prospective studies. Data extracted included the general and demographic characteristics of the studies, diagnostic methods used, clinical presentation, site of involvement and details on surgical treatment. : In total, 2870 patients with a diagnosis of abdominal tuberculosis were included, and 1803 (63%) underwent a surgical procedure. The majority of patients underwent an open surgical procedure (95%). The most commonly performed procedures were adhesiolysis (21%) and small bowel resection with primary anastomosis (21%). : The results of this review suggest that whenever surgery is required, there is a tendency to perform open surgical procedures in patients with complicated abdominal tuberculosis, both in emergency and elective settings, despite advances in minimally invasive surgery. The study protocol was registered on PROSPERO (CRD42022354322).
腹部结核包括累及胃肠道的所有结核形式。对于复杂型腹部结核的手术方式、手术时机及干预类型存在争议。本系统评价的目的是明确腹部结核的手术治疗率、所施行的手术类型以及微创手术在腹部结核管理中的作用。
在MEDLINE、Scopus和谷歌学术数据库中检索自建库至2022年7月发表的研究文献，不限语言，并检索其前后文引用文献。纳入所有前瞻性和回顾性研究。电子数据库检索共获得2440条记录。此外，通过滚雪球检索又识别出8条记录。去除重复记录（共发现45条重复记录）后，对2403条记录进行标题和摘要筛选。在筛选标题、摘要及排除标准后，纳入38篇报告进行系统评价，其中27篇为回顾性研究，11篇为前瞻性研究。提取的数据包括研究的一般和人口统计学特征、所采用的诊断方法、临床表现、受累部位及手术治疗细节。
总共纳入了2870例诊断为腹部结核的患者，其中1803例（63%）接受了手术治疗。大多数患者接受了开放手术（95%）。最常施行的手术是粘连松解术（21%）和小肠切除并一期吻合术（21%）。
本评价结果表明，尽管微创手术取得了进展，但对于复杂型腹部结核患者，无论在急诊还是择期情况下，只要需要手术，仍倾向于施行开放手术。本研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42022354322）。
