Newton N J, Sharrock A, Rickard R, Mughal M
Gastrointestinal Services, University College Hospital, London.
Centre for Blast Injury Studies Imperial College, London.
Dis Esophagus. 2017 Feb 1;30(3):1-5. doi: 10.1111/dote.12531.
Topical negative pressure is widely used in the management of superficial wounds. The use of this technology in the management of oesophageal perforations is becoming increasingly common. This systematic review aims to capture available evidence about its use in this setting. Medline and Embase were searched using MeSH terms and free text: esophageal perforation; esophageal injury; vacuum assisted closure; vacuum therapy device; esophagus; wounds penetrating; esophageal perforation; wound healing; negative pressure wound therapy. Searches were carried out between April and November 2015. Case series, cohort trials and controlled trials were included. Additional studies were found by hand searching reference lists. Eleven studies met the inclusion criteria with 180 patients. Nine of the studies were case series and two were retrospective comparisons of negative pressure with stents or clips. Healing of the perforation occurred in 163/179 patients and the overall mortality was 12.8%. Compared with published data on mortality from oesophageal perforation, the application of negative pressure appears to be beneficial. The studies are, however, limited to case series and retrospective cohort studies. The number of patients in each study is small and in the absence of randomized trials demonstrating a lack of bias firm conclusions cannot be made.
局部负压广泛应用于浅表伤口的处理。该技术在食管穿孔处理中的应用正变得越来越普遍。本系统评价旨在获取有关其在此情况下应用的现有证据。使用医学主题词和自由文本对Medline和Embase进行检索：食管穿孔；食管损伤；真空辅助闭合；负压治疗设备；食管；穿透性伤口；食管穿孔；伤口愈合；负压伤口治疗。检索于2015年4月至11月进行。纳入了病例系列、队列试验和对照试验。通过手工检索参考文献列表发现了其他研究。11项研究符合纳入标准，共180例患者。其中9项研究为病例系列，2项为负压与支架或夹子的回顾性比较。179例患者中有163例穿孔愈合，总死亡率为12.8%。与已发表的食管穿孔死亡率数据相比，负压的应用似乎是有益的。然而，这些研究仅限于病例系列和回顾性队列研究。每项研究中的患者数量较少，且由于缺乏随机试验来证明无偏倚，因此无法得出确凿的结论。
