Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
World J Emerg Surg. 2023 Mar 29;18(1):24. doi: 10.1186/s13017-023-00496-6.
Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.
The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I = 0%) in patients with peritonitis when compared to non-IOPL.
IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.
术中腹腔灌洗（IOPL）用生理盐水已广泛应用于外科实践中。然而，生理盐水在腹腔感染（IAIs）患者中的有效性仍存在争议。本研究旨在系统评价评价 IOPL 在 IAIs 患者中的有效性的随机对照试验（RCTs）。
检索 PubMed、Embase、Web of Science、Cochrane 图书馆、CNKI、万方和 CBM 数据库，检索时间截至 2022 年 12 月 31 日。使用随机效应模型计算风险比（RR）、均数差和标准化均数差。采用推荐评估、制定和评估（GRADE）对证据质量进行评级。
纳入 10 项 RCTs，共 1318 名参与者，其中 8 项关于阑尾炎，2 项关于腹膜炎。中质量证据表明，与非 IOPL 相比，生理盐水 IOPL 并未降低死亡率（0%比 1.1%；RR，0.31[95%CI，0.02-6.39]）、腹腔脓肿（12.3%比 11.8%；RR，1.02[95%CI，0.70-1.48]；I=24%）、切口手术部位感染（3.3%比 3.8%；RR，0.72[95%CI，0.18-2.86]；I=50%）、术后并发症（11.0%比 13.2%；RR，0.74[95%CI，0.39-1.41]；I=64%）、再次手术（2.9%比 1.7%；RR，1.71[95%CI，0.74-3.93]；I=0%）和再入院（5.2%比 6.6%；RR，0.95[95%CI，0.48-1.87]；I=7%）的风险。低质量证据表明，与非 IOPL 相比，生理盐水 IOPL 并未降低死亡率（22.7%比 23.3%；RR，0.97[95%CI，0.45-2.09]；I=0%）和腹腔脓肿（5.1%比 5.0%；RR，1.05[95%CI，0.16-6.98]；I=0%）的风险。
与非 IOPL 相比，生理盐水 IOPL 并未显著降低阑尾炎患者的死亡率、腹腔脓肿、切口手术部位感染、术后并发症、再次手术和再入院风险。这些发现不支持在阑尾炎患者中常规使用生理盐水 IOPL。生理盐水 IOPL 对其他类型腹部感染引起的 IAIs 的疗效仍需要进一步研究。
