Lin Yifei, Liao Banghua, Lai Sike, Huang Jin, Du Liang, Wang Kunjie, Li Hong
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
BMC Urol. 2019 Jan 10;19(1):5. doi: 10.1186/s12894-018-0435-3.
Barbed sutures can avoid knot tying and speed the suture placement in the PN(partial nephrectomy). On account of the impact on clinical outcomes are ambiguous, this study is determined to identify the application of barbed suture during PN.
ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed and EMBASE were searched for RCTs(randomized controlled trials) and cohort studies focusing on the comparison of barbed and traditional sutures in PN(last updated on Feb in 2015). According to Cochrane Library's suggestion, quality assessment was performed. Review Manager was applied to analyze all the data and sensitivity analyses were performed through omitting each study sequentially.
Eight cohort studies and none of RCTs proved eligible (risk of bias: moderate to low,431 patients). Warm ischemia time(MD = - 6.55,95% CI -8.86 to - 4.24, P < 0.05) decreased statistically in the barbed suture group, as well as operative time(MD = - 11.29,95% CI -17.87 to-4.71, P < 0.05). Postoperative complications also reduced significantly(OR = 0.44, 95% CI 0.24 to0.80, P < 0.05). Unidirectional barbed suture resulted in fewer postoperative complications based on the subgroup analysis(OR = 0.48,95% CI 0.24 to 0.94, P < 0.05).
The barbed suture may be a useful surgical innovation which can modify perioperative results for surgeons and patients. Randomly-designed studies with longer follow up and larger sample sizes are in the need of to explore the applicability.
倒刺缝线可避免打结并加快部分肾切除术（PN）中的缝合速度。鉴于其对临床结局的影响尚不明确，本研究旨在确定倒刺缝线在PN中的应用情况。
检索ClinicalTrials.gov、Cochrane临床研究注册库、PubMed和EMBASE，查找聚焦于比较PN中倒刺缝线与传统缝线的随机对照试验（RCT）和队列研究（最后更新于2015年2月）。按照Cochrane图书馆的建议进行质量评估。应用Review Manager分析所有数据，并通过依次剔除每项研究进行敏感性分析。
八项队列研究符合要求，无RCT符合要求（偏倚风险：中到低，431例患者）。倒刺缝线组的热缺血时间（MD = -6.55，95%CI -8.86至-4.24，P < 0.05）在统计学上有所降低，手术时间也是如此（MD = -11.29，95%CI -17.87至-4.71，P < 0.05）。术后并发症也显著减少（OR = 0.44，95%CI 0.24至0.80，P < 0.05）。基于亚组分析，单向倒刺缝线导致的术后并发症更少（OR = 0.48，95%CI 0.24至0.94，P < 0.05）。
倒刺缝线可能是一项有用的手术创新，可为外科医生和患者改善围手术期结局。需要开展随访时间更长、样本量更大的随机设计研究来探索其适用性。
