Nguyen A L, Pronk A A, Furnée E J B, Pronk A, Davids P H P, Smakman N
Department of Surgery, Diakonessenhuis, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands.
Tech Coloproctol. 2016 Feb;20(2):91-100. doi: 10.1007/s10151-015-1381-7. Epub 2015 Nov 6.
Surgical site infections occur in up to 24 % of patients after surgical excision of sacrococcygeal pilonidal sinus disease with primary wound closure. Local administration of antibiotics by a gentamicin collagen sponge could reduce this infection rate. The objective of this systematic review and meta-analysis was to evaluate the effect of a gentamicin collagen sponge on outcome after surgical excision in patients with sacrococcygeal pilonidal sinus disease. A structured literature search was performed in the PubMed, Embase, The Cochrane Library, and Scopus databases. Studies comparing surgical excision of sacrococcygeal pilonidal sinus disease with versus without a gentamicin collagen sponge were included. Outcome measures were surgical site infection, wound healing, and recurrence. The search strategy yielded six studies with a total of 669 patients. Three randomized controlled trials, comparing excision of pilonidal sinus disease and primary wound closure with versus without gentamicin collagen sponge, were eligible for inclusion in the meta-analysis (319 patients), demonstrating a trend towards reduced surgical site infections after administration of gentamicin collagen sponge [absolute risk reduction 20 %, 95 %-confidence interval (CI) 1-41 %, p = 0.06]. The wound healing (absolute risk reduction 22 %, 95 % CI 32-77 %, p = 0.42) and recurrence rate (absolute risk reduction 8 %, 95 % CI 7-22 %, p = 0.30) were not significantly different between both groups. Administration of a gentamicin collagen sponge after surgical excision of sacrococcygeal pilonidal sinus disease showed no significant influence on wound healing and recurrence rate, but a trend towards a reduced incidence of surgical site infections. Therefore, additional larger well-designed randomized controlled trials are required.
在采用一期伤口缝合手术切除骶尾部藏毛窦疾病后，高达24%的患者会发生手术部位感染。庆大霉素胶原海绵局部应用抗生素可降低这一感染率。本系统评价和荟萃分析的目的是评估庆大霉素胶原海绵对骶尾部藏毛窦疾病患者手术切除后结局的影响。在PubMed、Embase、Cochrane图书馆和Scopus数据库中进行了结构化文献检索。纳入比较有或没有庆大霉素胶原海绵的骶尾部藏毛窦疾病手术切除的研究。结局指标为手术部位感染、伤口愈合和复发情况。检索策略产生了6项研究，共669例患者。三项随机对照试验比较了有或没有庆大霉素胶原海绵的藏毛窦疾病切除及一期伤口缝合，符合纳入荟萃分析的条件（319例患者），结果显示使用庆大霉素胶原海绵后手术部位感染有降低趋势[绝对风险降低20%，95%置信区间（CI）1 - 41%，p = 0.06]。两组间伤口愈合（绝对风险降低22%，95% CI 32 - 77%，p = 0.42）和复发率（绝对风险降低8%，95% CI 7 - 22%，p = 0.30）无显著差异。骶尾部藏毛窦疾病手术切除后使用庆大霉素胶原海绵对伤口愈合和复发率无显著影响，但手术部位感染发生率有降低趋势。因此，需要更多设计良好的大型随机对照试验。
