Малоинвазивные методы лечения хронического воспаления эпителиального копчикового хода (систематический обзор литературы и метаанализ)

ЦЕЛЬ: провести систематический обзор литературы с целью обобщения информации, касающейся эффективности малоинвазивных методов лечения хронического воспаления эпителиального копчикового хода.

ПАЦИЕНТЫ И МЕТОДЫ: в систематический обзор включены результаты анализа 52 клинических исследований, отобранных из 2576 публикаций, найденных в базах данных. В рамках обзора приведены данные, касающиеся эффективности следующих методов: использования фибринового клея, синусэктомии, видеоассистируемого лечения ЭКХ, методов лазерной коагуляции и химической деструкции с использованием кристаллического фенола или его раствора. Относительно последних двух методов так же проведен метаанализ данных.

РЕЗУЛЬТАТЫ: при сравнительной оценке результатов применения фенола и методик, сопровождающихся радикальным иссечением ЭКХ, наблюдалась статистически значимая разница в сторону большей частоты осложнений после иссечения ЭКХ (ОШ 0,42; 95% ДИ: 0,05–3,71), при этом частота рецидивов статистически значимо не различалась между методиками (ОШ 0,98; 95% ДИ: 0,45–2,16). При применении SiLaC вероятность рецидива заболевания была статистически значимо выше, чем после методов с иссечением ЭКХ (ОШ 4,02; 95% ДИ: 1,13–14,3, р = 0,03). Однако по частоте развития осложнений между SiLaC и радикальным иссечением ЭКХ статистической значимости выявлено не было (ОШ 0,63; 95% ДИ: 0,29–1,34).

ЗАКЛЮЧЕНИЕ: проведенный анализ данных литературы продемонстрировал высокую эффективность большинства малоинвазивных методов, которые наряду с радикальными вмешательствами вошли в спектр регулярного использования при лечении хронического воспаления ЭКХ. В качестве наиболее перспективных следует выделить методики химической деструкции и лазерной коагуляции ЭКХ.

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