Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
Peking Union Medical College, PUMC, Beijing, 100730, China.
Int J Colorectal Dis. 2021 Aug;36(8):1633-1642. doi: 10.1007/s00384-021-03908-8. Epub 2021 Mar 15.
Due to lack of high-level evidences, prophylactic subcutaneous drainage has so far not been recommended in relevant guidelines as a countermeasure against incisional infections. This meta-analysis aims to clarify the efficacy of subcutaneous drainage in reducing incisional infections in colorectal surgeries.
Cochrane Library, Embase, and PubMed were searched for randomized controlled trials comparing the incidence rate of incisional infections between patients receiving prophylactic subcutaneous drainage (interventions) and those not receiving (controls) after digestive surgeries. Results from included RCTs were pooled multiple times according to different surgical types. Heterogeneity, publication bias, and certainty of evidences were estimated.
Eight randomized controlled trials were included. Three RCTs each included patients receiving all sorts of digestive surgeries (gastrointestinal, hepatobiliary, and pancreatic); pooled incisional infection rates between the drainage group and the control group were not significantly different (RR = 0.76, 95%CI: 0.48-1.21, p = 0.25). Four RCTs included patients receiving colorectal surgeries; pooled incisional infection rate in the drainage group was significantly lower than that in the control group (RR = 0.34, 95%CI: 0.19-0.61, p = 0.0004). Four RCTs included patients receiving upper GI and/or HBP surgeries; pooled incisional infection rates in the drainage group and the non-drainage group were not significantly different (RR = 0.85, 95%CI: 0.54-1.34, p = 0.49).
Prophylactic subcutaneous drainage significantly reduces post-operative incisional infections in colorectal surgeries but was not efficacious in digestive surgeries in general.
由于缺乏高级别的证据，预防性皮下引流术迄今尚未被相关指南推荐作为预防切口感染的措施。本荟萃分析旨在明确皮下引流术在降低结直肠手术后切口感染发生率方面的疗效。
检索 Cochrane Library、Embase 和 PubMed，纳入比较接受预防性皮下引流术（干预组）和未接受引流术（对照组）的消化系统手术后患者切口感染发生率的随机对照试验。根据不同的手术类型，对纳入的 RCT 结果进行多次汇总。评估异质性、发表偏倚和证据质量。
共纳入 8 项随机对照试验。其中 3 项 RCT 纳入了接受各种消化系统手术（胃肠道、肝胆胰）的患者；引流组与对照组之间的切口感染率无显著差异（RR=0.76，95%CI：0.48-1.21，p=0.25）。4 项 RCT 纳入了接受结直肠手术的患者；引流组的切口感染率明显低于对照组（RR=0.34，95%CI：0.19-0.61，p=0.0004）。4 项 RCT 纳入了接受上消化道和/或肝胆胰手术的患者；引流组和非引流组的切口感染率无显著差异（RR=0.85，95%CI：0.54-1.34，p=0.49）。
预防性皮下引流术可显著降低结直肠手术后的术后切口感染，但对一般消化系统手术无效。
