剖腹术后择期和急诊手术中预防性使用网片增强：荟萃分析。
Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis.
机构信息
General Surgery Residency, University of Pavia, Pavia, Italy.
Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
出版信息
BJS Open. 2023 Jul 10;7(4). doi: 10.1093/bjsopen/zrad060.
BACKGROUND
Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique.
METHODS
The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords 'laparotomy closure', 'mesh', 'mesh positioning', and 'prophylactic mesh', and including medical subject headings terms. Only RCTs reporting the incidence of incisional hernia and other wound complications after elective or emergency midline laparotomy, where patients were treated with prophylactic mesh augmentation or without mesh positioning, were included. The primary endpoint was to explore the risk of incisional hernia at different follow-up time points. The secondary endpoint was the risk of wound complications. The risk of bias for individual studies was assessed according to the Revised Cochrane risk-of-bias tools for randomized trials.
RESULTS
Eighteen RCTs, including 2659 patients, were retrieved. A reduction in the risk of incisional hernia at every time point was highlighted in the prophylactic mesh augmentation group (1 year, risk ratio 0.31, P = 0.0011; 2 years, risk ratio 0.44, P < 0.0001; 3 years, risk ratio 0.38, P = 0.0026; 4 years, risk ratio 0.38, P = 0.0257). An increased risk of wound complications was highlighted for patients undergoing mesh augmentation, although this was not significant.
CONCLUSIONS
Midline laparotomy closure with prophylactic mesh augmentation can be considered safe and effective in reducing the incidence of incisional hernia. Further trials are needed to identify the ideal type of mesh and technique for mesh positioning, but surgeons should consider prophylactic mesh augmentation to decrease incisional hernia rate, especially in high-risk patients for fascial dehiscence and even in emergency settings.
PROSPERO REGISTRATION ID
CRD42022336242 (https://www.crd.york.ac.uk/prospero/record_email.php).
背景
切口疝是剖腹术的一种常见短期和长期并发症，可导致严重的发病率。本系统评价和荟萃分析的目的是提供最新的概述，即在择期和紧急情况下使用预防性网片增强技术的剖腹术闭合方法。
方法
没有时间限制地在 2022 年 6 月 21 日之前筛选 Scopus、PubMed 和 Web of Science 数据库，使用关键词“剖腹术闭合”、“网片”、“网片定位”和“预防性网片”，并包括医学主题词。仅纳入报告择期或紧急中线剖腹术患者中使用预防性网片增强或无网片定位后切口疝和其他伤口并发症发生率的 RCT，评估的主要终点是不同随访时间点的切口疝风险。次要终点是伤口并发症的风险。根据修订后的 Cochrane 随机试验偏倚风险工具评估单个研究的偏倚风险。
结果
共检索到 18 项 RCT，包括 2659 例患者。预防性网片增强组在各个时间点切口疝风险降低（1 年，风险比 0.31，P = 0.0011；2 年，风险比 0.44，P < 0.0001；3 年，风险比 0.38，P = 0.0026；4 年，风险比 0.38，P = 0.0257）。尽管网片增强患者的伤口并发症风险增加，但无统计学意义。
结论
预防性网片增强的中线剖腹术闭合可被认为是安全有效的，可降低切口疝的发生率。需要进一步的试验来确定理想的网片类型和网片定位技术，但外科医生应考虑预防性网片增强以降低切口疝的发生率，尤其是在筋膜裂开高风险患者中，甚至在紧急情况下也是如此。
PROSPERO 注册号：CRD42022336242（https://www.crd.york.ac.uk/prospero/record_email.php）。
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