■几十年来,已经采取科学的努力来制定策略和医疗辅助手段,以减少肠道手术后吻合口并发症。尽管如此,吻合口漏(AL)是一种经常发生的术后并发症,对健康造成严重后果,生活质量,和经济方面。使用基于胶原蛋白和/或纤维蛋白的密封剂覆盖肠吻合的方法已显示出对减少泄漏的有希望的效果;然而,它们还没有达到常规使用。评估用胶原和/或纤维蛋白基封闭剂覆盖肠吻合对术后渗漏的影响,我们进行了系统评价和荟萃分析.
■PubMed,WebofScience,科克伦图书馆,和Scopus(1964年1月1日至2022年1月17日)进行了搜索,以确定研究用胶原蛋白和/或基于纤维蛋白的密封剂涂覆任何肠吻合对术后AL的影响的研究,再操作率,Clavien-Dindo严重并发症,死亡率,和住院时间。计算具有95%置信区间(CIs)的集合比值比(ORs)。
■总的来说,15项研究(5项随机对照试验,三项非随机干预研究,6项观察性队列研究)纳入干预组1,387例患者和对照组2,243例患者.使用固定效应荟萃分析(I2<50%),涂肠吻合术患者的AL率显着降低(OR=0.37;95%CI0.27-0.52;p<0.00001),再手术率(或,0.21;95%CI,0.10-0.47;p=0.0001),和Clavien-Dindo主要并发症发生率(OR,0.54;95%CI,0.35-0.84;p=0.006)与对照组相比,在敏感性和亚组分析中结果保持稳定(按研究设计分层,年龄组,使用干预措施,吻合位置,和手术指征)。干预组住院时间明显缩短(加权平均差异(WMD),-1.96;95%CI,-3.21,-0.71;p=0.002)使用随机效应荟萃分析(I2≥50%),特别是上消化道恶性肿瘤手术患者(WMD,-4.94;95%CI,-7.98,-1.90;p=0.001)。
■基于胶原的层状生物材料或纤维蛋白封闭剂在肠吻合上的应用可以显着降低AL及其后遗症的术后发生率。肠吻合的涂层可能是朝着有效和可持续的泄漏预防迈出的一步。为了评估这些发现的有效性和稳健性,需要进一步的临床研究.
UNASSIGNED: For several decades, scientific efforts have been taken to develop strategies and medical aids for the reduction of anastomotic complications after intestinal surgery. Still, anastomotic leakage (AL) represents a frequently occurring postoperative complication with serious consequences on health, quality of life, and economic aspects. Approaches using collagen and/or fibrin-based sealants to cover intestinal anastomoses have shown promising effects toward leak reduction; however, they have not reached routine use yet. To assess the effects of covering intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative leakage, a systematic
review and meta-analysis were conducted.
UNASSIGNED: PubMed, Web of Science, Cochrane Library, and Scopus (01/01/1964 to 17/01/2022) were searched to identify studies investigating the effects of coating any intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative AL, reoperation rates, Clavien-Dindo major complication, mortality, and hospitalization length. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
UNASSIGNED: Overall, 15 studies (five randomized controlled trials, three nonrandomized intervention studies, six observational cohort studies) examining 1,387 patients in the intervention group and 2,243 in the control group were included. Using fixed-effects meta-analysis (I 2 < 50%), patients with coated intestinal anastomoses presented significantly lower AL rates (OR = 0.37; 95% CI 0.27-0.52; p < 0.00001), reoperation rates (OR, 0.21; 95% CI, 0.10-0.47; p = 0.0001), and Clavien-Dindo major complication rates (OR, 0.54; 95% CI, 0.35-0.84; p = 0.006) in comparison to controls, with results remaining stable in sensitivity and subgroup analyses (stratified by study design, age group, intervention used, location of anastomoses, and indication for surgery). The length of hospitalization was significantly shorter in the intervention group (weighted mean difference (WMD), -1.96; 95% CI, -3.21, -0.71; p = 0.002) using random-effects meta-analysis (I 2 ≥ 50%), especially for patients with surgery of upper gastrointestinal malignancy (WMD, -4.94; 95% CI, -7.98, -1.90; p = 0.001).
UNASSIGNED: The application of collagen-based laminar biomaterials or fibrin sealants on intestinal anastomoses can significantly reduce postoperative rates of AL and its sequelae. Coating of intestinal anastomoses could be a step toward effective and sustainable leak prevention. To assess the validity and robustness of these findings, further clinical studies need to be conducted.