学术型外科医师如何撰写系统评价和Meta分析?

Systematic Review and Meta-analysis: Techniques and a Guide for the Academic Surgeon

随着外科学领域文献数量的快速增长,越来越需要对现有证据进行评价和总结,使其能够更适用于临床。当针对某一临床问题的高质量临床试验很少时,对系统评价的结果解释就比较困难。若坚持使用严格的评价方法 (包括全面的文献检索、主要研究的质量评价、恰当的统计学方法、对估计值和偏倚风险的信度评估等),就可以将偏倚风险降到最低,并可能得出有用结论。因此,本文的目的是:(1)总结外科学领域全面严格的系统评价和meta分析的重要特征;(2)强调几个未广泛应用的统计学方法 ,相对于传统的两两对照数据合成,这些方法可能会开拓更广泛有趣的视野;(3)为全面分析和结果撰写提供一个指南。

With the rapidly growing literature across the surgical disciplines, there is a corresponding need to critically appraise and summarize the currently available evidence so they can be applied appropriately to patient care. The interpretation of systematic reviews is particularly challenging in cases where few robust clinical trials have been performed to address a particular question. However, risk of bias can be minimized and potentially useful conclusions can be drawn if strict review methodology is adhered to, including an exhaustive literature search, quality appraisal of primary studies, appropriate statistical methodology, assessment of confidence in estimates and risk of bias. Therefore, the following article aims to： （Ⅰ） summarize to the important features of a thorough and rigorous systematic review or meta-analysis for the surgical literature; （Ⅱ） highlight several underused statistical approaches which may yield further interesting insights compared to conventional pair-wise data synthesis techniques; and （Ⅲ） propose a guide for thorough analysis and presentation of results.