背景:为了缓解直肠或肛门癌会阴切除术后的盆腔创伤问题,许多技术已被建议作为主要封闭的替代方案.这些方法包括使用生物/双重网格,网膜成形术,肌肉皮瓣,和/或盆腔腹膜闭合。此网络分析的目的是比较所有可用的手术技术,以减轻与空骨盆相关的问题。
方法:使用MEDLINE数据库(PubMed)的电子系统搜索,EMBASE,并进行了WebofScience(研究的最后日期是3月15日,2023年)。研究比较了至少两种上述用于腹部手术切除会阴伤口重建的手术技术,盆腔切除术,或额外的提上腹部手术切除包括在内。原发性愈合的发生率,并发症,和/或对会阴伤口的再干预进行了评估。此外,对会阴疝的总体发生率进行了评估.
结果:45项观察性研究和5项随机对照试验符合146,398例患者的纳入报告条件。就主要结果而言,所有手术技术均具有可比的风险比(RR)。合并网络分析显示,当将初次闭合(RR0.53;Crl0.33,0.89)与肌肉皮瓣进行比较时,会阴伤口感染的RR较低。当将网膜成形术(RR0.59;Crl0.38,0.95)和初次闭合(RR0.58;Crl0.46,0.77)与肌瓣进行比较时,会阴伤口裂开RR较低。
结论:在过去的几十年中,会阴伤口闭合的手术选择有了显著的发展。关于“最佳”选项尚未达成明确共识,为个人量身定制仍然是一个关键因素。
To mitigate pelvic wound issues following perineal excision of rectal or anal cancer, a number of techniques have been suggested as an alternative to primary closure. These methods include the use of a biological/dual mesh, omentoplasty, muscle flap, and/or pelvic peritoneum closure. The aim of this network analysis was to compare all the available surgical techniques used in the attempt to mitigate issues associated with an empty pelvis.
An electronic systematic search using MEDLINE databases (PubMed), EMBASE, and Web of Science was performed (Last date of research was March 15th, 2023). Studies comparing at least two of the aforementioned surgical techniques for perineal wound reconstruction during abdominoperineal resection, pelvic exenteration, or extra levator abdominoperineal excision were included. The incidence of primary healing, complication, and/or reintervention for perineal wound were evaluated. In addition, the overall incidence of perineal hernia was assessed.
Forty-five observational studies and five randomized controlled trials were eligible for inclusion reporting on 146,398 patients. All the surgical techniques had a comparable risk ratio (RR) in terms of primary outcomes. The pooled network analysis showed a lower RR for perineal wound infection when comparing primary closure (RR 0.53; Crl 0.33, 0.89) to muscle flap. The perineal wound dehiscence RR was lower when comparing both omentoplasty (RR 0.59; Crl 0.38, 0.95) and primary closure (RR 0.58; Crl 0.46, 0.77) to muscle flap.
Surgical options for perineal wound closure have evolved significantly over the last few decades. There remains no clear consensus on the \"best\" option, and tailoring to the individual remains a critical factor.