在患有二次腹膜炎的患者中,真空辅助关闭或按需进行复原切除术的初级关闭:系统性审查和元分析
Pooya Rajabaleyan1,2,3, Pedja Cuk4,5,6, Sören Möller7
1Research Unit for Surgery, Odense University Hospital, Odense, Denmark. Pooya.Rajabaleyan@skane.se.
World journal of emergency surgery : WJES
|May 21, 2025
概括
与初级腹关闭 (PAC) 相比,真空辅助关闭 (VAC) 增加了手术后并发症和二次腹膜炎的ICU停留时间. 然而,死亡率相似,证据质量低.
科学领域:
- 腹部外科手术 腹部外科手术
- 关键护理医学 关键护理医学
- 外科手术的结果
背景情况:
- 二次性腹膜炎需要紧急腹腔切除术来控制源.
- 真空辅助关闭 (VAC) 和初级腹部关闭 (PAC) 是管理腹腔解剖的关键策略.
- 人们担心VAC的并发症和长期结果与PAC相比.
研究的目的:
- 系统地审查和比较二次腹膜炎腹腔切除术患者的VAC与PAC的术后结果.
- 评估死亡率,并发症,切口,关闭和停留时间的差异.
主要方法:
- 按照PRISMA 2020和MOOSE指南进行系统审查.
- 使用Cochrane偏差风险 (RoB 2),MINORS和GRADE框架进行质量评估.
- 搜索了MEDLINE,Embase和Cochrane图书馆 (2004年1月至2024年8月) 的相关研究.
主要成果:
- VAC与更高的术后并发症 (71.0%对39.3%,p=0.001) 和更长的ICU停留 (21.1对9.7天,p=0.04) 相关.
- 二次关闭率与VAC (58.1%与85.9%,p<0.001) 相比显著较低.
- 死亡率 (31.1%对22.2%) 和切口率在各组之间相似;证据确定性低至非常低.
结论:
- 与PAC相比,VAC治疗与并发症增加,较低的关闭和更长的ICU停留有关.
- 没有观察到30天死亡率的显著差异.
- 偏见的高风险和证据的低确定性需要谨慎地解释研究结果.
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