减张缝合技术对腹部手术切口愈合质量影响的Meta分析

Effect of Tension Suture on Healing Quality of Incision after Abdominal Surgery:A Meta-Analysis

目的探讨减张缝合技术对腹部手术切口愈合质量的影响,为减少术后切口并发症的发生提供理论依据。方法对中国生物医学数据库、CNKI全文数据库及万方数据库收录的2005年1月至2015年1月期间发表的有关减张缝合技术在腹部手术切口中应用的一次文献进行Meta分析。结果纳入了8篇文献,共2 001例患者,其中减张缝合组1 044例,常规缝合组957例。Meta分析结果表明：减张缝合组可降低术后切口感染（OR=0.40,95%CI：0.28-0.57,P〈0.05）、切口区皮下脂肪液化（OR=0.51,95%CI：0.37-0.69,P〈0.05）、切口疝（OR=0.11,95%CI：0.04-0.34,P〈0.05）、切口裂开（OR=0.13,95%CI：0.07-0.25,P〈0.05）及二期手术缝合（OR=0.16,95%CI：0.09-0.30,P〈0.05）的发生率,增加切口区皮肤局部坏死的发生率（OR=15.14,95%CI：2.79-82.08,P〈0.05）,而对切口区皮下积血（OR=0.58,95%CI：0.30-1.13,P〉0.05）的发生没有影响。结论与常规缝合相比,减张缝合技术能降低切口感染、切口区皮下脂肪液化、切口疝、切口裂开和二期手术缝合的风险,增加切口区皮肤局部坏死的风险。

Objective To investigate the effect of tension suture on healing quality of incision after abdominal surgery, and to provide a theoretical basis for reducing post-operative wound complications. Methods Literatures on the tension suture in the application of abdominal incision were searched from January 2005 to January 2015, and then a Meta-analysis was carried out based on the data obtained from CBM, CNKI, and Wan Fang database. Results Eight articles involving 2 001 patients with abdominal surgery, including 1 044 cases in tension suture group, and 957 cases in the conventional suture group, were incorporated. The Meta analysis results showed that, the technique of tension suture could reduce the incidence of post-operative wound infection（OR=0.40, 95% CI： 0.28-0.57, P〈0.05）, fat liquefaction（OR=0.51, 95% CI： 0.37-0.69, P〈0.05）, incisional hernia（OR=0.11, 95% CI： 0.04-0.34, P〈0.05）, wound dehiscence（OR=0.13, 95% CI： 0.07-0.25, P〈0.05）, and second stage surgery（OR=0.16, 95% CI： 0.09-0.30, P〈0.05）. But, it would also augment the risk of post-operative skin incision necrosis（OR=15.14, 95% CI： 2.79-82.08, P〈0.05）. On the other hand, the method of tension suture had no effect on the subcutaneous hemorrhage in the incision area（OR=0.58, 95% CI： 0.30-1.13, P〉0.05）. Conclusions Compared with conventional suture, tension suture can reduce the hazard of wound infection, fat liquefaction, incisional hernia, wound dehiscence, and reoperation after abdominal surgery. In contrast, it can also increase the risk of post-operative skin incision necrosis.