选择性初级带的开放修复:一个系统的审查和元分析
Ana Caroline Dias Rasador1, Carlos André Balthazar da Silveira1, Diego Laurentino Lima2
1Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, BA, 40290-000, Brazil.
概括
与修复相比,网状修复显著降低了椎修复 (UHR) 的复发率,即使对于较小的缺陷. 虽然网状网络可能会增加血清瘤和感染风险,但在随机对照试验中没有看到这种情况,这支持在UHR中使用网状网络.
科学领域:
- 一般外科 整体外科
- 手术创新 在外科创新.
- Hernia 修复技术 的修复技术
背景情况:
- 指南建议用于椎修复 (UHR) 缺陷>1厘米,因为复发率较低.
- 主要关闭仍然很常见,特别是在小缺陷 (1-2厘米) 时,缺乏最佳方法数据.
- 以前的元分析存在局限性,包括不排除紧急或复发性,以及缺乏根据缺陷大小进行子组分析.
研究的目的:
- 进行系统性审查和元分析,比较网状修复与开放选择性初级UHR的初级接关闭.
- 专门分析2厘米以下的缺陷的结果.
- 为了评估复发,血清瘤,血瘤,伤口感染和住院时间.
主要方法:
- 在PubMed,Scopus,Cochrane,Scielo和Lilacs数据库中搜索到2023年10月.
- 排除了涉及18岁以下患者的研究,复发性或紧急.
- 仅对RCT和缺陷<2厘米进行了子组分析,使用RevMan 5.4进行分析.
主要成果:
- 包括12项涉及2926名患者的研究;网格修复显示整体复发率显著降低 (RR0.50) 和缺陷<2厘米 (RR0.56).
- 在整体分析中,修复的血清瘤 (RR 1.88) 和伤口感染 (RR 1.65) 率较低.
- 在RCT小组分析中,没有发现复发,血清瘤或感染的显著差异;在血液瘤或住院期间没有发现差异.
结论:
- 与修复相比,UHR中的网格修复与长期复发率明显较低有关,支持当前的指导方针.
- 虽然整体分析表明血清瘤和伤口感染的风险较高,但在RCT小组分析中,这些差异并不显著.
- 这些发现强化了网状使用作为开放选择性初级UHR的有利选择,特别是在减少复发方面.
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