Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
J Pediatr Surg. 2013 Apr;48(4):845-57. doi: 10.1016/j.jpedsurg.2013.01.020.
BACKGROUND/PURPOSE: Gastroschisis is the most common congenital abdominal wall defect. Despite advances in the surgical closure of gastroschisis, consensus is lacking as to which method results in the best patient outcomes. The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis.
We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012. Articles were identified using the search term "gastroschisis" and [("treatment outcome" or "prognosis") or randomized controlled trials]. Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were excluded from the meta-analysis. Two independent reviewers identified relevant articles for final inclusion. A standard data collection form created by the authors was used to extract study information, including study design, patient characteristics, and reported patient outcomes. The data were analyzed using standard meta-analytic techniques.
Twenty studies were included in the meta-analysis. In the five studies that selected closure method randomly or as a temporal shift in practice, silo was associated with better outcomes, with a significant reduction in ventilator days (p<0.0001), time to first feed (p=0.04), and infection rates (p=0.03). When all studies were included, primary closure was associated with improved outcomes.
Silo closure is associated with better clinical outcomes in the studies with the least selection bias. Larger prospective studies are needed to definitively determine the best closure technique.
背景/目的：先天性腹壁缺损中，腹裂最为常见。尽管在先天性腹壁缺损的手术修复方面取得了进步，但对于哪种方法能获得最佳的患者预后，目前仍缺乏共识。本荟萃分析的目的在于比较原发性筋膜闭合术与使用造口袋分期修复术治疗先天性腹壁缺损的短期疗效。
我们检索了 1996 年 1 月 1 日至 2012 年 6 月 1 日期间的 Medline 文献，并查阅了 Cochrane 系统评价数据库。使用的检索词为“gastroschisis”和[（“治疗结果”或“预后”）或随机对照试验]。排除了病例报告、综述、信件、仅摘要、非英文摘要以及未涉及至少一个感兴趣结局的研究。两名独立的审查员确定了最终纳入的相关文章。作者制定了一个标准的数据采集表，用于提取研究信息，包括研究设计、患者特征和报告的患者结局。使用标准的荟萃分析技术对数据进行分析。
共有 20 项研究纳入荟萃分析。在 5 项随机选择或按时间顺序选择闭合方法的研究中，使用造口袋的患者结局更好，呼吸机使用天数显著减少（p<0.0001）、首次喂养时间提前（p=0.04）、感染率降低（p=0.03）。当纳入所有研究时，原发性闭合术与更好的结局相关。
在选择偏倚最小的研究中，使用造口袋的闭合术与更好的临床结局相关。需要更大规模的前瞻性研究来明确哪种闭合技术最好。
