Gerken Andreas L H, Dobroschke Jakob, Reißfelder Christoph, Hetjens Svetlana, Braun Volker, Di Monta Gianlica, Jakob Jens, Hohenberger Peter, Nowak Kai, Herrle Florian
Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Visceral Surgery, University Hospital, Technical University Dresden, Dresden, Germany.
J Surg Oncol. 2019 May;119(6):728-736. doi: 10.1002/jso.25366. Epub 2019 Jan 23.
Postoperative lymphoceles and further wound complications occur frequently after radical inguinal lymph node dissection (ILND). In various studies, tissue sealants have shown to reduce the incidence of postoperative morbidity.
A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of tissue sealants in reducing the incidence of postoperative lymphoceles following ILND in patients with melanoma was conducted. Individual patient data was requested to pool the data for meta-analysis appropriately.
Thousand seven hundred twenty-nine manuscripts were screened for eligibility. Six RCTs published between 1986 and 2012 were identified including 194 patients for ILND. Only four RCTs were included in the meta-analysis. No study properly defined the term "lymphocele." Tissue sealants failed to influence the duration of drain placement (mean difference [MD] = -3.05 days; z = 1.18; P = 0.24), total drainage volume (MD = 598.39 mL; z = 1.49; P = 0.14), the incidence of postoperative seroma, wound infection and skin necrosis.
No improvement was identified with the use of tissue sealants, however, a valid comparison of the results of included trials was difficult owing to the lack of a definition of the term "lymphocele." Other surgical techniques and trials using validated endpoint definitions are required to reevaluate these findings.
根治性腹股沟淋巴结清扫术（ILND）后，术后淋巴囊肿及其他伤口并发症经常发生。在各项研究中，组织封闭剂已显示可降低术后发病率。
对研究组织封闭剂在降低黑色素瘤患者ILND术后淋巴囊肿发生率有效性的随机对照试验（RCT）进行系统评价和荟萃分析。要求提供个体患者数据以适当汇总数据进行荟萃分析。
筛选了1729篇手稿以确定其是否符合条件。确定了1986年至2012年间发表的6项RCT，包括194例行ILND的患者。荟萃分析仅纳入4项RCT。没有研究对“淋巴囊肿”一词进行恰当定义。组织封闭剂未能影响引流管放置时间（平均差[MD]= -3.05天；z = 1.18；P = 0.24）、总引流量（MD = 598.39 mL；z = 1.49；P = 0.14）、术后血清肿、伤口感染和皮肤坏死的发生率。
使用组织封闭剂未发现有改善，然而，由于缺乏对“淋巴囊肿”一词的定义，难以对纳入试验的结果进行有效比较。需要其他手术技术及使用经过验证的终点定义的试验来重新评估这些发现。
