Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Abstract Purpose: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. Methods: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. Results: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). Conclusions: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.摘要 目的：评估创伤性膈肌破裂最常用的手术入路，以及哪种入路下评估第二体腔的需求更为常见。 方法：本研究为系统综述，纳入观察性研究。 结局指标：手术入路时机、最常采用的入路方式，以及需开放另一体腔的需求情况。 检索数据库：拉丁美洲与加勒比卫生科学文献数据库（LILACS）、PubMed、Embase、ClinicalTrials.gov 及 Web of Science。 统计学分析：采用StatsDirect 3.0.121统计软件。 结果：共纳入68项研究，涉及2023名受试者。急性期手术入路的实施频次是慢性期的4倍。整体手术入路分布：经腹入路占65%（95%置信区间（Confidence Interval，CI）：63%~67%），经胸入路占23%（95%置信区间：21%~24%）；急性期经腹入路占75%（95%置信区间：71%~78%），慢性期经腹入路占24%（95%置信区间：19%~29%）；急性期经胸入路占12%（95%置信区间：10%~14%），慢性期经胸入路占69%（95%置信区间：63%~74%）。经腹入路中需切开胸腔的比例为10%（95%置信区间：8%~14%）；经胸入路中需切开腹腔的比例为15%（95%置信区间：7%~24%）。 结论：最常用的手术入路为经腹入路。急性期手术入路更为普遍。急性期经腹入路的使用频次高于经胸入路，慢性期经胸入路的使用频次高于经腹入路。两种入路下需开放第二体腔的需求比例相近。