Tullavardhana Thawatchai, Chartkitchareon Anuwat
Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand.
Oman Med J. 2022 Nov 30;37(6):e439. doi: 10.5001/omj.2022.61. eCollection 2022 Nov.
Giant perforation (size > 2 cm) is a catastrophic complication of peptic ulcer disease, which is difficult to repair and leads to postoperative leakage and 60% morbidity and 48.2% mortality rates. The objective of this meta-analysis was to compare the postoperative outcomes of omental plugging and omentopexy in the treatment of giant ulcer perforation.
The dataset was defined by searching for articles published until December 2020 from PubMed, Embase, Google Scholar, and the Cochrane database. The search terms included were giant peptic ulcer, peptic ulcer perforation, omentopexy, and omental plug. The data analysis included a study published in English that evaluated the surgical outcomes of omental plugging and omentopexy in the management of giant peptic ulcer perforation patients. Meta-analysis was performed using Review Manager software version 5.4.1.
A total of 175 articles were identified during the initial search. After review, eight articles were suitable for inclusion in the meta-analysis. A total of 367 patients were included in the final analysis. The findings demonstrate that when compared to the omentopexy group, the omental plugging technique significantly reduced overall postoperative complications (odds ratio (OR) = 0.29, 95% CI: 0.18-0.47, 0.0001) and bile leakage rate (OR = 0.18, 95% CI: 0.07-0.46, 0.0003), resulting in a significantly lower postoperative mortality rate (OR = 0.35, 95% CI: 0.17-0.69, 0.003). However, there was no significant difference in intraabdominal collection, respiratory tract, and wound infection rates between each surgical treatment group.
Omental plugging is a simple surgical procedure associated with fewer postoperative complications and mortality than omentopexy. This technique is a safe surgical treatment option for peptic ulcer perforations > 2 cm.
巨大穿孔（尺寸>2厘米）是消化性溃疡疾病的一种灾难性并发症，难以修复，会导致术后渗漏，发病率为60%，死亡率为48.2%。本荟萃分析的目的是比较网膜填塞术和网膜固定术治疗巨大溃疡穿孔的术后结果。
通过检索截至2020年12月在PubMed、Embase、谷歌学术和考克兰数据库上发表的文章来确定数据集。检索词包括巨大消化性溃疡、消化性溃疡穿孔、网膜固定术和网膜填塞。数据分析包括一项以英文发表的评估网膜填塞术和网膜固定术治疗巨大消化性溃疡穿孔患者手术结果的研究。使用Review Manager软件5.4.1版进行荟萃分析。
在初步检索中总共识别出175篇文章。经过审查，8篇文章适合纳入荟萃分析。最终分析共纳入367例患者。研究结果表明，与网膜固定术组相比，网膜填塞术显著降低了总体术后并发症（比值比（OR）=0.29，95%置信区间：0.18 - 0.47，P<0.0001）和胆汁渗漏率（OR = 0.18，95%置信区间：0.07 - 0.46，P<0.0003），术后死亡率显著降低（OR = 0.35，95%置信区间：0.17 - 0.69，P = 0.003）。然而，各手术治疗组之间在腹腔积液、呼吸道和伤口感染率方面没有显著差异。
网膜填塞术是一种简单的手术方法，与网膜固定术相比，术后并发症和死亡率更少。该技术是治疗直径>2厘米的消化性溃疡穿孔的一种安全的手术治疗选择。
