Division of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Suite D-365, 100 Woods Road, Valhalla, NY, 10595, USA.
Tech Coloproctol. 2019 Mar;23(3):207-220. doi: 10.1007/s10151-019-01952-9. Epub 2019 Feb 26.
There is no level 1a evidence regarding the best technique for skin closure at loop ileostomy reversal. The aim of this study was to evaluate whether purse-string skin closure (PSC) is associated with lower surgical site infection (SSI) rates as compared to linear skin closure (LC).
EMBASE, MEDLINE, Pubmed, Cochrane Library, Web of Science, and CINAHL databases were systematically searched. PSC was defined as a circumferential subcuticular suture leaving a small circular skin defect allowing for free drainage, granulation, and epithelialization. In LC, the wound edges were approximated side to side with or without drainage. The primary endpoint was SSI rate. Secondary endpoints included operating time, length of hospital stay, wound healing time, and incisional hernia rates.
Inclusion criterion was any observational or experimental study comparing PSC to LC in patients undergoing ostomy reversal.
Twenty studies (6 experimental and 14 observational) totaling 1812 patients (826 PSC and 986 LC) were included. SSI rates were significantly lower statistically and clinically in patients with PSC [OR (95% CI) = 0.14 (0.09, 0.21); p < 0.0001; NNT = 6] in the meta-analysis of all studies. The subgroup analysis of randomized trials [OR (95% CI) = 0.10 (0.04, 0.21); p < 0.0001; NNT = 6] as well as the analysis of randomized trials including patients with loop ileostomy only [OR (95% CI) = 0.12 (0.05, 0.28); p < 0.0001; NNT = 5] confirmed this finding.
This meta-analysis found that PSC was associated with significantly decreased rates of SSI in patients undergoing loop ileostomy reversal.
在回肠袢式造口还纳术中，哪种皮肤缝合技术最优尚无 1a 级证据。本研究旨在评估荷包缝合（PSC）与线性缝合（LC）相比，是否可降低手术部位感染（SSI）的发生率。
系统检索了 EMBASE、MEDLINE、PubMed、Cochrane 图书馆、Web of Science 和 CINAHL 数据库。PSC 定义为一种环行皮下缝线，留下一个小的圆形皮肤缺损，允许自由引流、肉芽形成和上皮化。LC 中，切口边缘侧向对合，有无引流均可。主要终点为 SSI 发生率。次要终点包括手术时间、住院时间、伤口愈合时间和切口疝发生率。
纳入标准为比较 PSC 与 LC 治疗行造口还纳术患者的任何观察性或实验性研究。
共纳入 20 项研究（6 项实验性研究和 14 项观察性研究），总计 1812 例患者（PSC 组 826 例，LC 组 986 例）。所有研究的荟萃分析显示，PSC 组患者 SSI 发生率显著低于 LC 组[比值比（OR）（95%可信区间）=0.14（0.09，0.21）；p<0.0001；NNH=6]。随机试验亚组分析[OR（95%可信区间）=0.10（0.04，0.21）；p<0.0001；NNH=6]和仅包括回肠袢式造口患者的随机试验分析[OR（95%可信区间）=0.12（0.05，0.28）；p<0.0001；NNH=5]证实了这一发现。
本荟萃分析发现，在接受回肠袢式造口还纳术的患者中，PSC 可显著降低 SSI 发生率。
