背景:本系统综述的目的是通过随访计算机断层扫描(CT)评估成人非手术治疗(NOM)脾损伤的假性动脉瘤(PSA)的估计发生率。
方法:在MEDLINE进行了系统的文献检索,中央,CINAHL,临床试验,2010年1月1日至2023年12月31日之间的ICTRP数据库。使用非随机暴露研究中的偏倚风险(ROBINS-E)工具进行质量评估。包括最初接受NOM治疗并接受原型CT随访的成人脾损伤患者。主要结果是延迟PSA的发生率。次要结果指标是延迟的血管造影和延迟的脾切除术。在无初始脾血管栓塞(SAE)的NOM患者和有初始SAE的NOM患者之间进行了亚组分析。
结果:纳入了12项研究,包括11项回顾性研究和一项前瞻性研究,共有1746名患者。纳入患者的随访CT率为94.9%。PSA的估计发生率为14%(95%置信区间(CI),8%-21%)。估计延迟血管造影和延迟脾切除的发生率分别为7%(95%CI,4%-12%)和2%(95%CI,1%-6%),分别。亚组分析显示,在没有初始SAE的NOM患者中,PSA的估计发生率为12%(95%CI,7%-20%),在有SAE的NOM患者中也为12%(95%CI,5%-24%)。
结论:成人NOM脾损伤随访CT后延迟PSA的估计发生率为14%。在具有初始SAE的NOM中,PSA的估计发生率与没有初始SAE的NOM相似。
BACKGROUND: The aim of this systematic review was to assess the estimated incidence of pseudoaneurysm (PSA) with follow-up computed tomography (CT) for adult splenic injury with nonoperative management (NOM).
METHODS: A systematic literature search was conducted in MEDLINE, Central, CINAHL, Clinical Trials, and ICTRP databases between January 1, 2010, and December 31, 2023. Quality assessment was performed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. Adult splenic injury patients who were initially managed with NOM and followed-up by protocolized CT were included. The primary outcome was the incidence of delayed PSA. Secondary outcome measures were delayed angiography and delayed splenectomy. Subgroup analyses were performed between NOM patients without initial splenic angioembolization (SAE) and NOM patients with initial SAE.
RESULTS: Twelve studies were enrolled, including 11 retrospective studies and one prospective study, with 1746 patients in total. The follow-up CT rate in the included patients was 94.9%. The estimated incidence of PSA was 14% (95% confidence interval (CI), 8%-21%). The estimated delayed angiography and delayed splenectomy incidence rates were 7% (95% CI, 4%-12%) and 2% (95% CI, 1%-6%), respectively. Subgroup analyses showed that the estimated PSA incidence was 12% in NOM patients without initial SAE (95% CI, 7%-20%) and was also 12% in NOM patients with SAE (95% CI, 5%-24%).
CONCLUSIONS: The estimated incidence of delayed PSA after follow-up CT for adult splenic injury with NOM was 14%. The estimated incidence of PSA in NOM with initial SAE was similar to that in NOM without initial SAE.