Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA,
World J Surg. 2014 Jan;38(1):40-50. doi: 10.1007/s00268-013-2232-1.
The current standard of treatment for most ventral hernias is a mesh-based repair. Little is known about the safety and efficacy of biologic versus nonbiologic grafts. A meta-analysis was performed to examine two primary outcomes: recurrence and wound complication rates.
Electronic databases and reference lists of relevant articles were systematically searched for all clinical trials and cohort studies published between January 1990 and January 2012. A total of eight retrospective studies, with 1,229 patients, were included in the final analysis.
Biologic grafts had significantly fewer infectious wound complications (p < 0.00001). However, the recurrence rates of biologic and nonbiologic mesh were not different. In subgroup analysis, there was no difference in recurrence rates and wound complications between human-derived and porcine-derived biologic grafts.
Use of biologic mesh for ventral hernia repair results in less infectious wound complications but similar recurrence rates compared to nonbiologic mesh. This supports the application of biologic mesh for ventral hernia repair in high-risk patients or patients with a previous history of wound infection only when the significant additional cost of these materials can be justified and synthetic mesh is considered inappropriate.
目前，大多数腹疝的标准治疗方法是使用网片修复。对于生物型和非生物型移植物的安全性和有效性知之甚少。进行了一项荟萃分析，以检查两个主要结局：复发率和伤口并发症发生率。
系统地检索了 1990 年 1 月至 2012 年 1 月之间发表的所有临床试验和队列研究的电子数据库和相关文章的参考文献列表。共有 8 项回顾性研究，涉及 1229 名患者，最终纳入了分析。
生物型移植物的感染性伤口并发症明显较少（p < 0.00001）。然而，生物型和非生物型网片的复发率没有差异。在亚组分析中，人源性和猪源性生物型移植物在复发率和伤口并发症方面没有差异。
与非生物型网片相比，使用生物型网片修复腹疝可减少感染性伤口并发症，但复发率没有差异。这支持在高风险患者或有既往伤口感染史的患者中应用生物型网片修复腹疝，只有在这些材料的显著额外成本可以证明合理且认为合成网片不合适的情况下。
