急诊剖腹术后预防性补片加固的长期随访。一项回顾性对照研究。
Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study.
作者信息
Bravo-Salva A, Argudo-Aguirre N, González-Castillo A M, Membrilla-Fernandez E, Sancho-Insenser J J, Grande-Posa L, Pera-Román M, Pereira-Rodríguez J A
机构信息
Servicio de Cirugía General Y del Aparato Digestivo, Parc de Salut Mar, Hospital del Mar, P. Marítim 23-25, 08003, Barcelona, Spain.
Departament de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Dr. Aiguader 88, 08003, Barcelona, Spain.
出版信息
BMC Surg. 2021 May 18;21(1):243. doi: 10.1186/s12893-021-01243-x.
BACKGROUND
Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies.
METHODS
This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared.
RESULTS
From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318-4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142-7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86-7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1-12.2; P = 0.001).
CONCLUSION
Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate.
TRIAL REGISTRATION
NCT04578561. www.clinicaltrials.gov.
背景
在急诊手术中使用预防性补片预防切口疝存在争议。本研究旨在分析预防性补片用于预防急诊正中剖腹术后切口疝的长期效果。
方法
本研究是一项注册研究（NCT04578561），对2009年1月至2010年7月期间接受急诊正中剖腹术且随访时间超过2年的患者进行回顾性分析。比较接受预防性加强补片（M组）和缝合（S组）的患者之间切口疝发生的长期结局和危险因素。
结果
最初的266例急诊正中剖腹术患者中，187例被纳入研究。中位随访时间为64.4个月（标准差35）。除M组既往手术率较高（62%对43.2%；P = 0.01）和因剖腹术翻修手术率较高（32.5%对13%；P = 0.02）外，两组具有相似特征。随访期间，29.9%的患者发生了切口疝（S组36.6%对M组14.3%；P = 0.002）。2例患者被诊断为慢性补片感染，但无需取出补片，且M组无患者发生慢性疼痛。切口疝的长期危险因素如下：吸烟（HR = 2.47；95%CI 1.318 - 4.624；P = 0.05）、污染手术（HR = 2.98；95%CI 1.142 - 7.8；P = 0.02）、手术部位感染（SSI；HR = 3.83；95%CI 1.86 - 7.86；P = 0.001）以及未使用预防性补片（HR = 5.09；95%CI 2.1 - 12.2；P = 0.001）。
结论
急诊正中剖腹术后切口疝的发生率较高且随时间增加。高危患者、污染手术和手术部位感染（SSI）从补片加强中获益。在急诊中使用预防性补片是安全可行的，长期并发症发生率较低。
试验注册
NCT04578561。www.clinicaltrials.gov。
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