癌症患者腹会阴联合切除术及盆腔脏器清除术后会阴伤口的缝合：一项系统评价与Meta分析

Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis.

作者信息

Buscail Etienne, Canivet Cindy, Shourick Jason, Chantalat Elodie, Carrere Nicolas, Duffas Jean-Pierre, Philis Antoine, Berard Emilie, Buscail Louis, Ghouti Laurent, Chaput Benoit

机构信息

Department of Digestive Surgery, Toulouse University Hospital, 31100 Toulouse, France.

INSERM, U1220, University of Toulouse, Digestive Health Research Institute (IRSD), 31100 Toulouse, France.

出版信息

Cancers (Basel). 2021 Feb 10;13(4):721. doi: 10.3390/cancers13040721.

BACKGROUND

Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis myocutaneous flap (VRAMf) and mesh closure on perineal morbidity following APR and PE (mainly for anal and rectal cancers).

METHODS

We searched PubMed, Cochrane, and EMBASE for eligible studies as of the year 2000. After data extraction, a meta-analysis was performed to compare perineal wound morbidity. The studies were distributed as follows: Group A comparing primary closure (PC) and VRAMf, Group B comparing PC and mesh closure, and Group C comparing PC and VRAMf in PE.

RESULTS

Our systematic review yielded 18 eligible studies involving 2180 patients (1206 primary closures, 647 flap closures, 327 mesh closures). The meta-analysis of Groups A and B showed PC to be associated with an increase in the rate of total (Group A: OR 0.55, 95% CI 0.43-0.71; < 0.01/Group B: OR 0.54, CI 0.17-1.68; = 0.18) and major perineal wound complications (Group A: OR 0.49, 95% CI 0.35-0.68; < 0.001/Group B: OR 0.38, 95% CI 0.12-1.17; < 0.01). PC was associated with a decrease in total (OR 2.46, 95% CI 1.39-4.35; < 0.01) and major (OR 1.67, 95% CI 0.90-3.08; = 0.1) perineal complications in Group C.

CONCLUSION

Our results confirm the contribution of the VRAMf in reducing major complications in APR. Similarly, biological prostheses offer an interesting alternative in pelvic reconstruction. For PE, an adapted reconstruction must be proposed with specialized expertise.

背景

腹会阴联合切除术（APR）和盆腔脏器清除术（PE）用于治疗癌症时，需要广泛的盆腔切除，术后并发症发生率较高。本研究的目的是系统评价和荟萃分析腹直肌肌皮瓣（VRAMf）和网状闭合术对APR和PE（主要用于肛管和直肠癌）后会阴发病率的影响。

方法

检索截至2000年的PubMed、Cochrane和EMBASE数据库中的相关研究。数据提取后，进行荟萃分析以比较会阴伤口发病率。研究分组如下：A组比较一期缝合（PC）和VRAMf；B组比较PC和网状闭合术；C组比较PE中的PC和VRAMf。

结果

我们的系统评价纳入了18项符合条件的研究，共2180例患者（1206例行一期缝合，647例行皮瓣闭合，327例行网状闭合）。A组和B组的荟萃分析显示，PC与总并发症发生率增加相关（A组：OR 0.55，95%CI 0.43-0.71；P<0.01/B组：OR 0.54，CI 0.17-1.68；P = 0.18）以及主要会阴伤口并发症发生率增加相关（A组：OR 0.49，95%CI 0.35-0.68；P<0.001/B组：OR 0.38，95%CI 0.12-1.17；P<0.01）。C组中，PC与总会阴并发症（OR 2.46，95%CI 1.39-4.35；P<0.01）和主要会阴并发症（OR 1.67，95%CI 0.90-3.08；P = 0.1）减少相关。