原发性补片增强术作为预防切口疝的预防措施的荟萃分析。

Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia.

机构信息

Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

出版信息

Dig Surg. 2013;30(4-6):401-9. doi: 10.1159/000355956. Epub 2013 Nov 5.

DOI:10.1159/000355956

PMID:24217341

Abstract

BACKGROUND

Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery. As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity. This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS).

METHODS

A meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included.

RESULTS

Out of 576 papers, 5 RCTs were selected comprising 346 patients. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I(2)0%; p < 0.001). No difference could be observed with regard to wound infection (RR 0.86, 95% CI 0.39-1.91, I(2) 0%; p = 0.71) or seroma (RR 1.22, 95% CI 0.64-2.33, I(2) 0%; p = 0.55). A trend was observed for chronic pain in favor of the PS group (RR 5.95, 95% CI 0.74-48.03, I(2)0%; p = 0.09).

CONCLUSION

The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS.

摘要

背景

切口疝（IH）仍然是腹部手术后最常见的术后并发症之一。因此，一种增强腹壁的技术——原发性补片增强术（PMA）越来越受欢迎。本荟萃分析旨在评估与原发性缝合（PS）相比，PMA 对 IH 发生率的预防效果。

方法

根据 PRISMA 指南进行荟萃分析。纳入比较 PMA 和 PS 用于腹部手术后关闭腹壁的随机对照试验（RCT）。

结果

在 576 篇论文中，选择了 5 项 RCT，共纳入 346 名患者。PMA 组 IH 的发生率明显较低（RR 0.25，95%CI 0.12-0.52，I(2)0%；p < 0.001）。两组之间在伤口感染（RR 0.86，95%CI 0.39-1.91，I(2)0%；p = 0.71）或血清肿（RR 1.22，95%CI 0.64-2.33，I(2)0%；p = 0.55）方面无差异。PS 组慢性疼痛的发生率有增加的趋势（RR 5.95，95%CI 0.74-48.03，I(2)0%；p = 0.09）。