不同皮肤闭合方式对肠造口回纳术后并发症影响的网状meta分析  

Effect of different skin closure techniques on postoperative complications of stoma reversal:a network meta-analysis

作　　者：蒋维荣 王蕊 曹栋 孙斌杰 李云锋 俞永江[3] JIANG Weirong;WANG Rui;CAO Dong;SUN Binjie;LI Yunfeng;YU Yongjiang(The First School of Clinical Medicine of Lanzhou University,Lanzhou 730030,P.R.China;The Second School of Clinical Medicine of Lanzhou University,Lanzhou 730030,P.R.China;Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730030,P.R.China)

机构地区：[1]兰州大学第一临床医学院,兰州730030 [2]兰州大学第二临床医学院,兰州730030 [3]兰州大学第一医院普外科,兰州730030

出　　处：《中国普外基础与临床杂志》2022年第3期353-361,共9页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的采用网状meta分析方法评价肠造口闭合手术中6种不同皮肤闭合方式的疗效和安全性。方法检索CNKI、WanFang Data、VIP、CBM、Cochrane Library、PubMed、Embase和Web of Science数据库,搜集肠造口回纳手术中不同皮肤闭合方式间比较的RCT研究,检索时限均为建库至2021年2月1日,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata MP16.0和R 3.6.1软件进行网状meta分析。结果共纳入16个RCT,包括2139例患者,比较了线性缝合、荷包缝合、十字缝合、线性缝合+引流、荷包缝合+引流和线性缝合+生物补片6种不同皮肤闭合方式对手术效果的影响。网状meta分析结果显示:传统的线性缝合术后手术部位感染(surgical site infection,SSI)发生率高于荷包缝合[RR=6.04,95%CI(3.11,16.89),P<0.0001]、十字缝合[RR=10.75,95%CI(1.12,152.12),P=0.04]和线性缝合+引流[RR=3.18,95%CI(1.24,10.20),P=0.03],荷包缝合术后SSI发生率低于线性缝合+生物补片[RR=0.15,95%CI(0.01,0.88),P=0.03];线性缝合的术后住院时间较线性缝合+引流更长[MD=1.16,95%CI(0.29,2.20),P=0.02]。结论初步分析结果提示:荷包缝合和十字缝合在降低术后SSI方面有较好表现;加入引流不能进一步降低术后感染的发生率;单纯的荷包缝合或十字缝合可能是肠造口闭合术式中较优的皮肤闭合方式;造口回纳时置入生物补片可能不会增加术后感染的风险。Objective To compare the clinical effectiveness of different skin closure techniques in stoma reversal using network meta-analysis.Methods CNKI,WanFang Data,VIP,CBM,Cochrane Library,PubMed,Embase,and Web of Science databases were searched until February 1,2021,and randomized controlled trials(RCTs)comparing outcomes between different skin closure techniques were included.Data were processed using Stata MP16.0 and R 3.6.1.Results The results demonstrated that 16 RCTs(n=2139)were eligible for pooling.Six types of skin closure techniques were used:linear closure,purse-string closure,gunsight closure,linear closure and drainage,purse-string closure and drainage,and linear closure and biological mesh.Network meta-analysis indicated that the incidence of postoperative infection with linear closure was higher than that with purse-string closure[RR=6.04,95%CI(3.11,16.89),P<0.0001],gunsight closure[RR=10.75,95%CI(1.12,152.12),P=0.04],and linear closure and drainage[RR=3.18,95%CI(1.24,10.20),P=0.03].The purse-string closure was superior to linear closure and biological mesh[RR=0.15,95%CI(0.01,0.88),P=0.03]in reducing postoperative infection.The length of hospital stay after linear suture was longer than that after linear suture and drainage[MD=1.16,95%CI(0.29,2.20),P=0.02].Conclusions This network meta-analysis suggests that purse-string closure and gunsight closure might be best for reducing postoperative infection,and the addition of drainage could not further reduce the incidence of postoperative infection.In addition,implantation of the biological mesh does not increase the risk of postoperative infection.However,a large-scale RCT is warranted to confirm the results.

关 键 词：肠造口 皮肤闭合 生物补片 术后感染 网状meta分析 

分 类 号：R656.7[医药卫生—外科学]