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腹壁正中切口关闭缝合的荟萃分析

Meta-analysis of suture techniques for midline abdominal incisions

摘要:

目的 以相关的文献资料,对腹壁正中切口缝合关闭技术的安全性和疗效进行荟萃分析.方法 查询MedLine和Embase数据库中1981至2009年有关腹壁正中切口关闭缝合的文献,要求为具有1年以上随访、采用不同缝合技术和(或)不同缝线材料进行腹壁正中切口关腹的随机对照研究.分析指标包括切口疝、伤口裂开、伤口感染、缝线窦道形成等.结果 共纳入文献13篇,共计6263例患者.与连续缝合相比,间断缝合切口疝发生率明显增加(OR=0.80,95%CI:0.66~1.00;P=0.05),两种缝合方式在切口裂开、切口感染和窦道形成方面无显著差异.与连续不吸收缝线缝合相比,采用连续快吸收缝线的切口疝发生率显著增加(8.3%比15.8%,P<0.05);而连续不吸收缝线缝合的窦道形成发生率更高(5.6%比1.0%,P<0.05).与连续慢吸收缝线缝合相比,连续快吸收缝线缝合切口疝发生率更高(10.0%比15.8%,P<0.05);与间断快吸收缝线缝合相比,使用间断不吸收缝线缝合窦道形成发生率更高(0比8.8%,P<0.05);连续慢吸收缝线缝合与连续不吸收缝线缝合相比,两者切口疝、切口感染、切口裂开发生率等差异无统计学意义,而连续不吸收缝线缝合窦道形成发生率会明显增加(OR=0.47,95%CI:0.24~0.92;P<0.05).连续缝合时,缝线长度与切口长度比值(SL/WL)<4∶1与≥4∶1相比,切口裂开、切口感染差异无统计学意义;但SL/WL<4:l时切口疝发生率会明显增加(P<0.05).结论 腹壁正中切口缝合关闭以连续全层(SL/WL为≥4∶1)慢吸收缝线关腹为宜,适宜的关腹技术和材料,可以明显减少切口裂开、切口感染和切口疝的发生.

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abstracts:

Objective To evaluate the safety and efficacy of suture techniques for midline abdominal incisions with systematic review and meta-analysis. Methods The articles about suture techniques for midline abdominal incisions published from year of 1981 to 2009 in MedLine and Embase databases were retrieved. All the trials with a minimal follow-up of one year that randomized patients for midline laparotomy with different suture techniques and/or suture materials were subjected to meta-analysis.The outcomes included incisional hernia, wound dehiscence, wound infection and suture sinus formation.Results Total of 13 articles were collected in this analysis. Compared with continuous sutures,interrupted sutures had significantly more incisional hernias (OR=0.80,95% CI:0.66-1.00;P=0.05). Continuous rapidly absorbable suture was associated with significantly more incisional hernias than continuous slowly absorbable suture or continuous non-absorbable suture ( 15. 8%, 10. 0% and 8.3%, respectively; P <0. 05). More suture sinuses occurred in patients with continuous non-absorbable suture than in those with continuous rapidly absorbable suture (5.6% w. 1.0%, P < 0.05 ); And more suture sinuses occurred in patients with interrupted non-absorbable suture than in those with interrupted rapidly absorbable suture (8.8% vs. 0, P<0.05 ) . Compared with continuous slowly absorbable suture, more suture sinuses occurred in patients with continuous non-absorbable suture (OR=0.47, 95% CI: 0.24-0.92;P <0.05).Less incisional hernias occurred in patients with a suture length/wound length ratio (SL/WL) of ≥4∶1 than those with the ratio less than 4∶1 (P<0.05). Conclusion To reduce the incidence of incisional hernia without increasing wound infection frequency, the ideal suture technique is mass closure using a continuous suture, with an adequate suture length/wound length ratio no less than 4∶1, the suture materials should be slowly absorbable.

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