La Regina Davide, Mongelli Francesco, Cafarotti Stefano, Saporito Andrea, Ceppi Marcello, Di Giuseppe Matteo, Ferrario di Tor Vajana Antonjacopo
Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Department of Anaesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
BMC Surg. 2018 Nov 19;18(1):102. doi: 10.1186/s12893-018-0442-z.
Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections.
Inclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate.
cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were ("gallbladder"AND("speciment"OR"extraction"OR"extract"))OR("gallbladder"OR"cholecystectomy")AND("bag"OR"retrieval|"OR|"endobag"OR"endocatch").
The comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41-1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern.
The results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed.
手术部位感染使2.4%-3.2%的择期腹腔镜胆囊切除术复杂化。手术过程中，胆囊通常用取物袋取出。我们进行了一项荟萃分析，以阐明使用取物袋是否对预防感染有作用。
纳入标准：择期胆囊切除术、胆囊取出的详细情况以及局部或全身感染率的数据。
胆囊炎、黄疸、同时进行抗生素治疗、免疫抑制、癌症。两名研究人员根据PRISMA指南并应用GRADE方法，独立对PubMed、Cochrane图书馆和MEDLINE数据库进行了全面的文献检索。使用的检索词为（“胆囊”且（“标本”或“取出”或“提取”））或（“胆囊”或“胆囊切除术”）且（“袋子”或“取物”或“内袋”或“内捕器”）。
全面的文献检索共找到279篇文章。符合条件的研究为2项随机试验和1项多中心前瞻性研究。使用取物袋进行手术的334例患者中有14例（4.2%）记录有伤口感染，而未使用取物袋进行手术的271例患者中有16例（5.9%）记录有伤口感染。统计分析显示风险比（RR）为0.82（0.41-1.63，95%CI）。关于敏感性分析，估计的合并RR范围为0.72至0.96，两者均无统计学意义。哈伯德检验未显示存在小研究效应（p = 0.892），漏斗图也未显示出明显模式。
本综述结果突出了设计良好的大型研究的匮乏，尽管证据水平较低存在局限性，但我们的荟萃分析表明，取物袋在降低择期腹腔镜胆囊切除术后感染率方面没有显著益处。在没有急性胆囊炎、术中意外胆囊穿孔或疑似癌的情况下，目前使用取物袋可能并非必需，因此，需要进一步针对复杂病例进行研究。
