den Hartog Dennis, Dur Alphons H M, Tuinebreijer Wim E, Kreis Robert W
Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 's Gravendijkwal 230, Rotterdam, Netherlands, 3000 CA.
Cochrane Database Syst Rev. 2008 Jul 16;2008(3):CD006438. doi: 10.1002/14651858.CD006438.pub2.
Incisional hernias occur frequently after abdominal surgery and can cause serious complications. The choice of a type of open operative repair is controversial. Determining the type of open operative repair is controversial, as the recurrence rate may be as high as 54%.
To identify the best available open operative techniques for incisional hernias.
Electronic databases MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1990 to 2007 and trials were identified from the known trial reference lists.
Studies were eligible for inclusion if they were randomized trials comparing different techniques for open operative techniques for incisional hernias.
Statistical analyses were performed using the fixed effects model. Results were expressed as relative risk for dichotomous outcomes and weighted mean difference for continuous outcomes with 95% confidence intervals.
Eight trials comparing different open repairs for incisional hernias were identified; one trial was excluded. The included studies enrolled 1,141 patients. The results of three trials comparing suture repair versus mesh repair were pooled. Hernia recurrence was more frequent, wound infection less frequent in the direct suture group compared to the onlay or sublay mesh groups. The recurrence rates of two trials comparing onlay and sublay positions were pooled. This comparison yielded no difference in recurrences (two studies pooled), although operation time was shorter in the onlay group (one study). No difference was found in recurrence, satisfaction with cosmetics, or infection between the onlay standard mesh and skin autograft groups, following analysis pooling the two treatment arms. However, the analysis demonstrated less pain in the skin autograft group. Other trials comparing different mesh materials or different positions of the mesh, or comparing mesh with the components separation technique are described individually. The comparison between lightweight and standard mesh showed a trend for more recurrences in the lightweight group. The comparison between onlay and intraperitoneal mesh positions resulted in non significant fewer hernia recurrences, less seroma formation and more postoperative pain in the intraperitoneal group. No differences in the recurrence rates between the components separation and the intraperitoneal mesh technique.
AUTHORS' CONCLUSIONS: There is good evidence from three trials that open mesh repair is superior to suture repair in terms of recurrences, but inferior when considering wound infection. Six trials yielded insufficient evidence as to which type of mesh or which mesh position (on- or sublay) should be used. There was also insufficient evidence to advocate the use of the components separation technique.
切口疝在腹部手术后频繁发生，可导致严重并发症。开放手术修复方式的选择存在争议。确定开放手术修复方式存在争议，因为复发率可能高达54%。
确定用于切口疝的最佳可用开放手术技术。
检索了1990年至2007年的电子数据库MEDLINE、EMBASE、LILACS以及Cochrane对照试验中央注册库（CENTRAL），并从已知的试验参考文献列表中识别试验。
如果研究是比较切口疝开放手术不同技术的随机试验，则有资格纳入。
采用固定效应模型进行统计分析。结果以二分结局的相对风险和连续结局的加权平均差表示，并带有95%置信区间。
确定了八项比较切口疝不同开放修复方式的试验；排除了一项试验。纳入的研究共纳入1141例患者。汇总了三项比较缝合修复与补片修复的试验结果。与覆盖或衬入补片组相比，直接缝合组疝复发更频繁，伤口感染更少。汇总了两项比较覆盖和衬入位置的试验的复发率。尽管覆盖组手术时间较短（一项研究），但该比较在复发方面没有差异（两项研究汇总）。在对两个治疗组进行分析汇总后，覆盖标准补片组和自体皮肤移植组在复发、美容满意度或感染方面没有差异。然而，分析表明自体皮肤移植组疼痛较轻。描述了其他比较不同补片材料或补片不同位置，或比较补片与组织分离技术的试验。轻质补片与标准补片的比较显示轻质补片组复发趋势更明显。覆盖补片与腹腔内补片位置的比较结果显示，腹腔内补片组疝复发明显减少、血清肿形成减少，但术后疼痛更多。组织分离技术与腹腔内补片技术在复发率上没有差异。
三项试验有充分证据表明，在复发方面开放补片修复优于缝合修复，但在伤口感染方面则较差。六项试验没有提供足够证据表明应使用哪种类型的补片或补片位置（覆盖或衬入）。也没有足够证据支持使用组织分离技术。
