Wadewitz Elisabeth, Friedrichs Juliane, Grilli Maurizio, Vey Johannes A, Zimmermann Samuel, Sunami Yoshiaki, Kleeff Jörg, Ronellenfitsch Ulrich, Klose Johannes, Rebelo Artur
Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin Luther University Halle Wittenberg, Halle, Germany.
Library of the Medical Faculty Mannheim, Mannheim, Germany.
Langenbecks Arch Surg. 2025 Sep 5;410(1):266. doi: 10.1007/s00423-025-03848-9.
This network meta-analysis (NMA) aims to evaluate surgical and alternative treatment strategies for perforated peptic ulcers (PPU) with respect to mortality and other clinically relevant outcomes.
An NMA was conducted in accordance with PRISMA guidelines to assess treatment approaches for PPU. Randomized controlled trials (RCT) were identified through systematic searches of PubMed/MEDLINE, Cochrane Library, Embase, CINAHL, ClinicalTrials.gov, and ICTRP databases. Outcomes were analyzed using standardized mean differences (SMDs) for continuous data and odds ratios (ORs) for binary data, both presented with 95% confidence intervals (CI) in a network meta-analysis framework.
Sixteen studies comprising 1,259 patients were included in this NMA. The laparoscopic approach demonstrated significantly reduced mortality (OR 0.36, 95% CI 0.17-0.75, p = 0.0065) and postoperative complications, including wound infections (OR 0.15, 95% CI 0.08-0.27, p < 0.0001) and ileus (OR 0.33, 95% CI 0.18-0.59), compared to the open surgical approach.
This NMA, particularly the pairwise analysis, confirms the significant advantages of laparoscopic over open surgery, reinforcing its status as the gold standard for PPU. The potential benefits of alternative approaches, are inconclusive due to insufficient evidence.
本网络荟萃分析（NMA）旨在评估穿孔性消化性溃疡（PPU）的手术及其他替代治疗策略在死亡率和其他临床相关结局方面的情况。
按照PRISMA指南进行NMA，以评估PPU的治疗方法。通过对PubMed/MEDLINE、Cochrane图书馆、Embase、CINAHL、ClinicalTrials.gov和ICTRP数据库进行系统检索，确定随机对照试验（RCT）。在网络荟萃分析框架中，对连续数据使用标准化均数差（SMD），对二分类数据使用比值比（OR）分析结局，并给出95%置信区间（CI）。
本NMA纳入了16项研究，共1259例患者。与开放手术相比，腹腔镜手术方法显示死亡率显著降低（OR 0.36，95% CI 0.17 - 0.75，p = 0.0065），术后并发症包括伤口感染（OR 0.15，95% CI 0.08 - 0.27，p < 0.0001）和肠梗阻（OR 0.33，95% CI 0.18 - 0.59）也显著降低。
本NMA，尤其是成对分析，证实了腹腔镜手术相对于开放手术具有显著优势，强化了其作为PPU金标准的地位。由于证据不足，替代方法的潜在益处尚无定论。
