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直肠癌腹会阴联合切除术后应用垂直腹直肌肌皮瓣和网片关闭会阴切口的并发症:一项荟萃分析。

Perineal wound complications after vertical rectus abdominis myocutaneous flap and mesh closure following abdominoperineal surgery and pelvic exenteration of anal and rectal cancers: A meta-analysis.

机构信息

Department of Anorectal Surgery, Shaoxing People's Hospital, Zhejiang, China.

出版信息

Int Wound J. 2023 Dec;20(10):3963-3973. doi: 10.1111/iwj.14284. Epub 2023 Aug 4.

Abstract

A meta-analysis research was implemented to appraise the perineal wound complications (PWCs) after vertical rectus abdominis myocutaneous (VRAM) flap and mesh closure (MC) following abdominoperineal surgery (AS) and pelvic exenteration (PE) of anal and rectal cancers. Inclusive literature research till April 2023 was done and 2008 interconnected researches were revised. Of the 20 picked researches, enclosed 2972 AS and PE of anal and rectal cancers persons were in the utilized researchers' starting point, 1216 of them were utilizing VRAM flap, and 1756 were primary closure (PC). Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequence of VRAM flap in treating AS and PE of anal and rectal cancers by the dichotomous approach and a fixed or random model. VRAM flap had significantly lower PWCs (OR, 0.64; 95% CI, 0.42-0.98, p < 0.001), and major PWCs (OR, 0.50; 95% CI, 0.32-0.80, p = 0.004) compared to PC in AS and PE of anal and rectal cancers persons. However, VRAM flap and PC had no significant difference in minor PWCs (OR, 1; 95% CI, 0.54-1.85, p = 1.00) in AS and PE of anal and rectal cancer persons. VRAM flap had significantly lower PWCs, and major PWCs, however, no significant difference was found in minor PWCs compared to PC in AS and PE of anal and rectal cancers persons. However, caution needs to be taken when interacting with its values since there was a low sample size of most of the chosen research found for the comparisons in the meta-analysis.

摘要

一项荟萃分析研究评估了经肛门会阴联合切除术(APR)和盆腔脏器切除术(PE)后行垂直直肌腹前肌肌皮瓣(VRAM)和网片修补(MC)的会阴伤口并发症(PWC)。进行了截至 2023 年 4 月的全面文献检索,并对 2008 项相关研究进行了修订。在纳入的 20 项研究中,纳入了 2972 名接受 APR 和 PE 的肛门和直肠癌症患者,这些患者是研究起点,其中 1216 名患者接受 VRAM 皮瓣,1756 名患者接受直接缝合(PC)。采用二项式方法和固定或随机模型,用比值比(OR)和 95%置信区间(CI)评估 VRAM 皮瓣治疗肛门和直肠癌症患者 APR 和 PE 的结果。与 PC 相比,VRAM 皮瓣显著降低了 APR 和 PE 肛门和直肠癌症患者的 PWC(OR,0.64;95%CI,0.42-0.98,p<0.001)和主要 PWC(OR,0.50;95%CI,0.32-0.80,p=0.004)。然而,VRAM 皮瓣和 PC 在前瞻性和 PE 肛门和直肠癌症患者的次要 PWC 方面无显著差异(OR,1;95%CI,0.54-1.85,p=1.00)。与 PC 相比,VRAM 皮瓣在 APR 和 PE 肛门和直肠癌症患者中具有更低的 PWC 和主要 PWC,但在次要 PWC 方面无显著差异。然而,在分析中进行比较时,由于大多数选择的研究的样本量较低,因此在解释其结果时需要谨慎。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c91e/10681467/b8a04d71ea78/IWJ-20-3963-g006.jpg

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