Cross Wirt, Kumar Ajay, Chandru Kowdley Gopal
Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland, USA.
Am Surg. 2014 Jan;80(1):3-8.
Ventral hernia repair in contaminated fields is a significant problem for surgeons. We performed a systematic review regarding the use of biological mesh in contaminated fields for abdominal wall reconstruction. The primary end points were recurrence and infection of the hernia repair. An independent search of scientific papers in the English language was performed by three reviewers. Articles were chosen based on reference to ventral hernias, their use in infected fields, and in human subjects. Papers were scored using the Methodological Index for Non-Randomized Studies and those with a score of 8 or more were combined to evaluate the end points. A total of 16 studies from six different mesh products met our criteria. These papers comprised 554 patients with an overall infection rate of 24 per cent and a recurrence rate of 20 per cent. The largest study used 116 patients. All papers were case series. Overall the data for use of biological mesh products in contaminated fields are limited. Further controlled studies are needed to address this important and clinically relevant question. Caution should be used when using biological mesh products in infected fields because there is a paucity of controlled data and none have U.S. Food and Drug Administration approval for use in infected fields.
在污染区域进行腹疝修补术对外科医生来说是一个重大难题。我们针对在污染区域使用生物补片进行腹壁重建展开了一项系统评价。主要终点指标是疝修补术的复发和感染情况。由三位评审人员独立检索英文科学文献。根据文献中对腹疝、其在感染区域的应用以及在人体受试者中的应用的提及来选取文章。使用非随机研究方法学指数对论文进行评分，得分8分及以上的论文被汇总以评估终点指标。来自六种不同补片产品的16项研究符合我们的标准。这些论文涵盖554例患者，总体感染率为24%，复发率为20%。规模最大的研究纳入了116例患者。所有论文均为病例系列研究。总体而言，在污染区域使用生物补片产品的数据有限。需要进一步开展对照研究来解决这个重要且与临床相关的问题。在感染区域使用生物补片产品时应谨慎，因为对照数据匮乏，且尚无产品获得美国食品药品监督管理局批准用于感染区域。
