摘要
目的比较生物补片与直接缝合在经肛提肌外腹会阴联合切除术(ELAPE)后修复盆底缺损的会阴相关并发症及其发生率。方法检索PubMed、Embase、Cochrane Library、Web of Science、万方数据库、中国期刊全文数据库、维普中文期刊数据库及中国生物医学文献数据库中公开发表的关于比较ELAPE术后生物补片和直接缝合修复盆底缺损的会阴相关并发症的临床研究,检索时间限定在2007年1月至2020年8月。文献纳入标准:(1)研究对象:经肠镜病理活检或手术病理证实为直肠癌,并进行肛提肌外腹会阴联合切除术;(2)研究类型:关于经肛提肌外腹会阴联合切除术后采用生物补片和直接缝合方式修复盆底缺损,并对两种盆底重建方式进行术后会阴并发症比较的随机对照研究或观察性对照研究;(3)干预措施:试验组直肠癌患者使用生物补片修复ELAPE术后盆底缺损,对照组直肠癌患者采用直接缝合方式;(4)结局指标:纳入文献需至少包含以下术后会阴并发症之一:会阴伤口感染、会阴伤口裂开、会阴疝、慢性窦道、慢性会阴疼痛、排尿障碍及性功能障碍等。文献排除标准:(1)重复发表的研究;(2)原始数据不完整或错误,以及无法获取原始数据的研究。由两名研究者独立筛选文献和提取资料,并评价文献质量。采用Review Manager 5.3软件进行Meta分析,比较两种盆底重建方式的会阴相关并发症发生情况,包括总体会阴伤口并发症、伤口感染、伤口裂开、会阴疝、慢性窦道及会阴慢性疼痛(术后12个月)等。最后评估发表偏倚,采用敏感性分析评价结果的稳定性。结果最终纳入5篇文献,包括2项随机对照研究和3项观察性研究,共计纳入650例患者,其中399例采用生物补片重建,251例采用直接缝合。Meta分析结果显示,与直接缝合相比,生物补片重建能显著降低术后会阴疝发生率(RR=0.37,95% CI:0.21~0.64,P<0.001);两组间的总体会阴伤口并发症发生率、伤口感染发生率、伤口裂开发生率、慢性窦道发生率以及会阴慢性疼痛(术后12个月)发生率比较,差异均无统计学意义(均P>0.05)。结论与直接缝合相比,生物补片重建ELAPE术后盆底缺损具有会阴疝发生率较低的优势。
Objective To compare the morbidity of perineum-related complication between biological mesh and primary closure in closing pelvic floor defects following extralevator abdominoperineal excision(ELAPE).Methods A literature search was performed in PubMed,Embase,Cochrane Library,Web of Science,Wanfang database,Chinese National Knowledge Infrastructure,VIP database,and China Biological Medicine database for published clinical researches on perineum-related complications following ELAPE between January 2007 and August 2020.Literature inclusion criteria:(1)study subjects:patients undergoing ELAPE with rectal cancers confirmed by colonoscopy pathological biopsy or surgical pathology;(2)study types:randomized controlled studies or observational studies comparing the postoperative perineum-related complications between the two groups(primary perineal closure and reconstruction with a biological mesh)following ELAPE;(3)intervention measures:biological mesh reconstruction used as the treatment group,and primary closure used as the control group;(4)outcome measures:the included literatures should at least include one of the following postoperative perineal complications:overall perineal wound complications,perineal wound infection,perineal wound dehiscence,perineal hernia,chronic sinus,chronic perineal pain(postoperative 12-month),urinary dysfunction and sexual dysfunction.Literature exclusion criteria:(1)data published repeatedly;(2)study with incomplete or wrong original data and unable to obtain original data.Two reviewers independently performed screening,data extraction and assessment on the quality of included studies.Review Manager 5.3 software was used for meta-analysis.The mobidities of perineum-related complications,including overall perineal wound(infection,dehiscence,hernia,chronic sinus)and perineal chronic pain(postoperative 12-month),were compared between the two pelvic floor reconstruction methods.Finally,publication bias was assessed,and sensitivity analysis was used to evaluate the stability of the results.Results A total of five studies,including two randomized controlled studies and three observational controlled studies,with 650 patients(399 cases in the biological mesh group and 251 cases in primary closure group)were finally included.Compared with primary closure,biological mesh reconstruction had significantly lower ratio of perineal hernia(RR=0.37,95%CI:0.21-0.64,P<0.001).No significant differences in ratios of overall perineal wound complication,perineal wound infection,perineal wound dehiscence,perineal chronic sinus and perineal chronic pain(postoperative 12-month)were found between the two groups(all P>0.05).Conclusion Compared with primary closure,pelvic floor reconstruction following ELAPE with biological mesh has the advantage of a lower incidence of perineal hernia.
作者
陶禹
王振军
韩加刚
Tao Yu;Wang Zhenjun;Han Jiagang(Department of General Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2021年第10期910-918,共9页
Chinese Journal of Gastrointestinal Surgery
