■本文的目的是探讨腹腔镜结直肠切除术(LCR)后标本提取部位发生切口疝(IH)的风险,强调横向切口与中线垂直腹部切口之间的比较。
■根据PRISMA指南进行分析。系统搜索医学数据库,EMBASE,MEDLINE,进行了PubMed和Cochrane图书馆,以查找所有类型的比较研究,这些研究报告了LCR后横向或垂直中线切口标本提取部位IH的发生率。使用RevMan统计软件对合并数据进行分析。
■对10,362名患者进行的25项比较研究(包括2项随机对照试验)符合纳入标准。横向切口组有4,944例患者,垂直中线切口组有5,418例患者。在随机效应模型分析中,LCR后使用横向切口进行标本提取降低了IH发展的风险(比值比=0.30,95%CI:0.19-0.49,Z=4.88,P=0.00001).然而,纳入研究存在显著异质性(Tau2=0.97;Chi2=109.98,df=24,P=0.00004;I2=78%).这项研究的局限性是由于缺乏随机对照试验,本研究包括前瞻性研究和回顾性研究以及2项RCT,这使得meta分析在证据来源上有潜在的偏倚.
■与垂直中线腹部切口相比,LCR后用于标本提取的横向切口似乎降低了术后IH发生率的风险。
UNASSIGNED: The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.
UNASSIGNED: Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.
UNASSIGNED: Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau2=0.97; Chi2=109.98, df=24, P=0.00004; I2=78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence.
UNASSIGNED: Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.