目的:硬化治疗静脉畸形已被广泛使用;然而,目前尚无评估不同硬化剂疗效的指南.我们进行了系统评价和网络荟萃分析,以研究硬化剂治疗静脉畸形的有效性。
方法:从成立(1950年)到2021年4月29日搜索了三个电子数据库。包括比较不同硬化剂的有效性的研究。评估了研究内部和研究之间的偏倚风险。进行了成对荟萃分析,其次是网络荟萃分析。我们还使用各种方法评估了不一致性和出版偏见。
结果:本研究包括7项研究,包括6组547名患者。我们将反应和完全反应定义为两个独立的结果。在反应方面的四个比较中观察到显着差异(乙醇与博来霉素,乙醇与脊髓灰质炎,乙醇与十四烷基硫酸钠,policocanolvs十四烷基硫酸钠)。在其他比较中没有发现统计学上的显着差异。证据网络显示,对于响应结果,乙醇排名第一,其次是平阳霉素,脊髓灰质炎,鱼油酸钠,博来霉素,and,最后,十四烷基硫酸钠。对于完整的响应结果,平阳霉素效果最好,其次是鱼油酸钠,脊髓灰质炎,乙醇,博来霉素,and,最后,十四烷基硫酸钠。主要并发症,比如面神经麻痹,严重的局部肿胀,和坏死,主要发生在乙醇组,很少发生在其他组。由于数据有限,未对主要并发症进行进一步分析.我们对比较和排名的信心很低。在使用现有方法的本研究中,我们没有发现经过验证的不一致或发表偏见。
结论:与其他药物相比,乙醇在统计学上显示出明显更好的反应。然而,乙醇也导致并发症发生率最高.平阳霉素表现出第二好的反应,最佳完整响应,并发症发生率低,分别。总的来说,平阳霉素在不同结果方面取得了优异的性能和平衡。然而,从现有数据中无法充分推荐它们。更优越的试验,尤其是随机对照试验,是未来需要的。
Sclerotherapy for venous malformation has been widely used; however, no guidelines are available to assess the effectiveness of different sclerotherapy agents. We conducted a systematic
review and network meta-analysis to investigate the effectiveness of sclerotherapy agents for venous malformations.
Three electronic databases were searched from their inception (1950) to April 29, 2021. Studies comparing the effectiveness of different sclerotherapy agents were included. The risk of bias within and across studies was assessed. Pairwise meta-analyses were conducted, followed by a network meta-analysis. We also assessed inconsistency and publishing bias using various approaches.
Seven studies with 547 patients in six arms were included in the present study. We defined the response and complete response as two separate outcomes. Significant differences were observed in four comparisons with respect to the response (ethanol vs bleomycin, ethanol vs
polidocanol, ethanol vs sodium tetradecyl sulfate,
polidocanol vs sodium tetradecyl sulfate). No statistically significant differences were found in the other comparisons. The evidence network revealed that for the response outcome, ethanol ranked first, followed by pingyangmycin,
polidocanol, sodium morrhuate, bleomycin, and, finally, sodium tetradecyl sulfate. For the complete response outcome, pingyangmycin had the best results, followed by sodium morrhuate,
polidocanol, ethanol, bleomycin, and, finally, sodium tetradecyl sulfate. Major complications, such as facial nerve palsy, serious local swelling, and necrosis, had occurred mostly in the ethanol group and rarely in the other groups. Because of the limited data, no further analysis of major complications was conducted. Our confidence in the comparisons and rankings was low. We found no verified inconsistency or publishing bias in the present study using the existing approaches.
Ethanol showed a significantly better response statistically compared with the other agents. However, ethanol had also resulted in the highest incidence of complications. Pingyangmycin showed the second-best response, best complete response, and a low rate of complications, respectively. Overall, pingyangmycin achieved excellent performance and balance in terms of the different outcomes. However, they could not be adequately recommended from the available data. More superior trials, especially randomized controlled trials, are needed in the future.