造口关闭术后环形（荷包缝合法）与一期皮肤缝合：最新的系统评价和荟萃分析。
Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis.
作者信息
Menegon Tasselli F, Pata F, Fuschillo G, Signoriello G, Bondurri A, Sciaudone G, Selvaggi F, Pellino G
机构信息
Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy.
出版信息
Tech Coloproctol. 2025 Apr 5;29(1):93. doi: 10.1007/s10151-025-03135-1.
BACKGROUND
Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure.
METHOD
A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia.
RESULTS
Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06-0.21; p < 0.00001, I = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD - 0.17, 95% CI - 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD - 0.34, 95% CI - 0.55, - 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31).
CONCLUSION
CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery.
背景
手术部位感染（SSI）是造口关闭术后最常见的并发症。有人提出采用环形皮肤缝合（CSC）来减少SSI，其效果与传统的一期缝合（PS）相当，甚至更好。本荟萃分析的目的是比较造口关闭术中环形皮肤缝合与一期皮肤缝合的效果。
方法
对2010年1月至2023年6月发表的文章进行系统文献回顾，纳入所有关于成年患者造口回纳术后伤口感染的随机对照试验（RCT）。主要结局是30天手术部位感染；次要结局是手术时间、住院时间和切口疝。
结果
共纳入8项RCT，总计606例接受造口关闭手术的患者。CSC组4%的患者发生SSI，而接受PS的患者为27%。环形皮肤缝合后30天手术部位感染率较低（比值比0.11，95%置信区间0.06 - 0.21；p < 0.00001，I² = 0%）。手术时间（99.2分钟对103.5分钟；平均差 -0.17，95%置信区间 -0.37，0.03；p = 0.10）、住院时间（7.1天对7.7天；平均差 -0.34，95%置信区间 -0.55，-0.12；p = 0.002）和切口疝发生率（2%对4%；比值比0.61，95%置信区间0.23，1.60；p = 0.31）无差异。
结论
CSC与较低的SSI率相关，造口关闭手术后应优先于线性皮肤缝合技术。
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