Kouzu Keita, Tsujimoto Hironori, Shinji Seiichi, Shinkawa Hiroji, Tamura Koji, Sato Yukio, Munakata Koji, Fukuda Yasunari, Koike Daisuke, Miyake Hiromu, Hosoda Yohei, Uchino Motoi, Ohge Hiroki, Shimizu Junzo, Haji Seiji, Mohri Yasuhiko, Yamashita Chizuru, Kitagawa Yuichi, Kobayashi Motomu, Hanai Yuki, Nobuhara Hiroshi, Yoshida Masahiro, Mizuguchi Toru, Mayumi Toshihiko, Kitagawa Yuko
Department of Surgery National Defense Medical College Saitama Japan.
Department of Gastroenterological Surgery Nippon Medical School Japan.
Ann Gastroenterol Surg. 2025 Jan 8;9(3):408-417. doi: 10.1002/ags3.12909. eCollection 2025 May.
This is a systematic review and meta-analysis of the efficacy of wound coverage using advanced dressings specifically for the prevention of surgical site infections (SSI) in gastrointestinal surgery, as part of the update of the SSI prevention guidelines of the Japan Society for Surgical Infection (JSSI).
After searching CENTRAL, PubMed, and ICHUSHI-Web in July 2024, we included randomized controlled trials (RCTs) comparing advanced dressings and standard dressings for surgical wounds in gastrointestinal surgery (PROSPERO No. CRD42024569084). Three authors independently screened the RCTs. We assessed the risk of bias and certainty of the body of evidence for the extracted data. The primary outcome was superficial SSI, and the secondary outcomes were length of postoperative hospital stay, costs, and allergy. This study was partially supported by the JSSI.
A total of seven RCTs and 927 patients were included. The use of advanced dressings significantly lowered the risk of SSI compared to that associated with standard dressings (risk ratio: 0.54, 95% confidence intervals: 0.34-0.88). The certainty of the evidence was rated as moderate. According to the subgroup analysis, advanced dressings reduced the risk of SSI in colorectal surgery. Advanced dressings did not reduce the length of postoperative hospital stay or costs compared to that of standard dressings. Allergies were reported in only one patient using silver-impregnated dressings.
The use of advanced dressings for primary wounds in gastrointestinal surgery was associated with a significantly lower risk of SSI than that associated with standard dressings.
作为日本外科感染学会（JSSI）手术部位感染预防指南更新的一部分，本研究对使用高级敷料预防胃肠外科手术部位感染（SSI）的疗效进行了系统评价和荟萃分析。
2024年7月检索CENTRAL、PubMed和ICHUSHI-Web后，我们纳入了比较胃肠外科手术伤口使用高级敷料和标准敷料的随机对照试验（RCT）（PROSPERO编号：CRD42024569084）。三位作者独立筛选RCT。我们评估了提取数据的偏倚风险和证据的确定性。主要结局是浅表SSI，次要结局是术后住院时间、费用和过敏反应。本研究部分得到JSSI的支持。
共纳入7项RCT和927例患者。与标准敷料相比，使用高级敷料显著降低了SSI的风险（风险比：0.54，95%置信区间：0.34-0.88）。证据的确定性被评为中等。根据亚组分析，高级敷料降低了结直肠手术中SSI的风险。与标准敷料相比，高级敷料并未缩短术后住院时间或降低费用。仅1例使用含银敷料的患者报告了过敏反应。
胃肠外科手术中使用高级敷料处理原发性伤口与SSI风险显著低于标准敷料相关。
