Davey S, Rajaretnem N, Harji D, Rees J, Messenger D, Smart N J, Pathak S
North Bristol NHS Trust, Bristol, UK.
University Hospitals Plymouth, Crownhill, Plymouth, UK.
Ann R Coll Surg Engl. 2020 Nov;102(9):663-671. doi: 10.1308/rcsann.2020.0163. Epub 2020 Aug 18.
Evidence suggests that midline incisions should be closed with the small-bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions.
A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow-up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken.
Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as 'other'. The pooled incidence of IH was 6.0% (2.0-10.0%) at a weighted mean follow-up of 17.5 months in the transverse group, compared with 15.0% (11.0-19.0%) at a weighted mean follow-up of 42.0 months in the hybrid group ( = 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups.
Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high-quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.
有证据表明，中线切口应采用小咬合法缝合以减少切口疝（IH）形成。对于肝胆外科手术中使用的横向切口的缝合，尚无相关建议。本研究系统总结了这些横向切口的IH形成率及相关技术因素。
进行了系统检索。纳入描述IH发生率的研究。切口分为横向（两种切口类型）或混合型（横向加中线延长，包括五种切口类型）。主要结局指标为IH的合并比例。基于至少两年的随访以及对IH进行临床和影像学诊断的先验定义进行亚组分析。
共纳入13项研究，涉及5427例患者；1427例患者（26.3%）接受了良性疾病手术，3465例（63.8%）接受了恶性肿瘤手术，535例（9.9%）接受了未明确说明或归类为“其他”疾病的手术。横向组在加权平均随访17.5个月时，IH的合并发生率为6.0%（2.0 - 10.0%），而混合型组在加权平均随访42.0个月时，IH的合并发生率为15.0%（11.0 - 19.0%）（P = 0.045）。亚组分析未显示混合型组与横向组在IH形成方面存在统计学差异。
由于研究设计的局限性和异质性，在肝胰胆外科手术中，指导切口选择和缝合方法的证据有限。迫切需要开展高质量的前瞻性队列研究，以了解所采用的技术及其结果，为未来研究提供参考。
