Lee Lawrence, Mata Juan, Landry Tara, Khwaja Kosar A, Vassiliou Melina C, Fried Gerald M, Feldman Liane S
Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, E19-125, Montreal, QC, H3G 1A4, Canada,
Surg Endosc. 2014 Sep;28(9):2531-46. doi: 10.1007/s00464-014-3499-5. Epub 2014 Mar 12.
Guidelines recommend the use of bioprosthetics for abdominal wall reinforcement in contaminated fields, but the evidence supporting the use of biologic over synthetic non-absorbable prosthetics for this indication is poor. Therefore, the objective was to perform a systematic review of outcomes after synthetic non-absorbable and biologic prosthetics for ventral hernia repair or prophylaxis in contaminated fields.
The systematic literature search identified all articles published up to 2013 that reported outcomes after abdominal wall reinforcement using synthetic non-absorbable or biologic prosthetics in contaminated fields. Studies were included if they included at least 10 cases (excluding inguinal and parastomal hernias). Quality assessment was performed using the MINORS instrument. The main outcomes measures were the incidence of wound infection and hernia at follow-up. Weighted pooled proportions were calculated using a random effects model.
A total of 32 studies met the inclusion criteria and were included for synthesis. Mean sample size was 41.4 (range 10-190), and duration of follow-up was >1 year in 72 % of studies. Overall quality was low (mean 6.2, range 1-12). Pooled wound infection rates were 31.6 % (95 % CI 14.5-48.7) with biologic and 6.4 % (95 % CI 3.4-9.4) with synthetic non-absorbable prosthetics in clean-contaminated cases, with similar hernia rates. In contaminated and/or dirty fields, wound infection rates were similar, but pooled hernia rates were 27.2 % (95 % CI 9.5-44.9) with biologic and 3.2 % (95 % CI 0.0-11.0) with synthetic non-absorbable. Other outcomes were comparable.
The available evidence is limited, but does not support the superiority of biologic over synthetic non-absorbable prosthetics in contaminated fields.
指南推荐在污染区域使用生物补片进行腹壁加强，但支持在此适应证中使用生物补片而非合成不可吸收补片的证据不足。因此，本研究的目的是对合成不可吸收补片和生物补片用于污染区域腹疝修补或预防后的结局进行系统评价。
系统检索文献，纳入截至2013年发表的所有报道在污染区域使用合成不可吸收补片或生物补片进行腹壁加强后结局的文章。纳入标准为至少包含10例病例（不包括腹股沟疝和造口旁疝）的研究。使用MINORS工具进行质量评估。主要结局指标为随访时伤口感染和疝的发生率。采用随机效应模型计算加权合并比例。
共有32项研究符合纳入标准并纳入分析。平均样本量为41.4（范围10 - 190），72%的研究随访时间>1年。总体质量较低（平均6.2，范围1 - 12）。在清洁 - 污染病例中，生物补片的合并伤口感染率为31.6%（95%CI 14.5 - 48.7），合成不可吸收补片为6.4%（95%CI 3.4 - 9.4），疝发生率相似。在污染和/或脏污区域，伤口感染率相似，但生物补片的合并疝发生率为27.2%（95%CI 9.5 - 44.9），合成不可吸收补片为3.2%（95%CI 0.0 - 11.0）。其他结局相当。
现有证据有限，但不支持在污染区域生物补片优于合成不可吸收补片。
