成人のヘルニアのメッシュ対縫合修復:ランダム化,二重盲検,多センター試験
Ruth Kaufmann1, Jens A Halm2, Hasan H Eker3
1Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands.
Lancet (London, England)
|February 21, 2018
まとめ
メッシュ修復は,従来の縫合修復と比較して,より小さなヘルニア (1~4cm直径) の再発率を大幅に減少させます. この研究は,これらの一般的な腹壁の欠陥に対するメッシュの使用を支持する高レベルの証拠を提供します.
科学分野:
- 外科手術
- 胃腸内科
- 医療技術
背景:
- 椎間板ヘルニアは一般的であり,メッシュと縫合の修復技術の両方が使用されます.
- 小型の椎間板ヘルニア (1~4cm) のメッシュ優位性の証拠は限られている.
- この研究は,小型の椎間板ヘルニアに対するメッシュと縫合修復の比較効果を扱っています.
研究 の 目的:
- 小型の椎間板ヘルニア (直径1~4cm) の再発率を減少させる点で,メッシュ修復が縫合修復より優れているかどうかを調査する.
主な方法:
- ランダム化され,ダブルブラインド,制御された多センター試験で,プライマリヘルニア (1~4cm) の300人の成人患者が参加した.
- 患者は無作為に (1:1) 術内メッシュ修復または縫合修復に割り当てられました.
- フォローアップには身体検査と超音波があり,再発率は24ヶ月で評価されました.
主要な成果:
- 24ヶ月で縫合修復 (12%) と比較して,メッシュ修復が有意に減少した (p=0. 01).
- 2年後の精算学的再発率は3. 6%で,縫合修復は11. 4%でした.
- 血清腫のような術後の合併症は,マッシュでわずかに多く見られたが,全体的に合併症率は低く,死亡者は発生しなかった.
結論:
- この研究は,小さな椎間板ヘルニア (1〜4cm) の場合,マッシュ修復が縫合修復よりも効果的であることを示す高レベルの証拠を提供します.
- このサイズ範囲内の椎間板ヘルニアの手術治療にはメッシュ修復が推奨されます.
- 発見は,より小さな椎間板ヘルニアのメッシュ利用への移行を支持します.
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