VSD联合植皮对比传统打包植皮治疗体表大面积皮肤缺损临床疗效的Meta分析

Meta-analysis on the effect of VSD combined with free skin graft in the treatment of large area skin defect comparing with traditional pressurized packaging technology

目的:评价应用VSD联合植皮对比传统打包植皮治疗体表大面积皮肤缺损的临床疗效。方法:计算机检索Cochrane Library、Pubmed、万方、中国知网,以"负压封闭引流"、"植皮"、"大面积皮肤缺损"为关键词,期限为2010年1月-2015年12月,检索所有关于负压封闭引流联合植皮治疗大面积皮肤缺损的RCT或CCT,对照组干预措施为传统打包植皮,并检索纳入文献的参考文献,防止漏查。对最终所纳入的研究进行方法学质量评价,然后通过Rev Man5.2软件行Meta分析。结果:共纳入16个研究,实验组VSD联合植皮715例,对照组普通打包植皮546例,共1261例大面积皮肤缺损患者。Meta分析结果显示:两组的皮片成活率有统计学差异[OR=7.77,95%CI(5.12,11.79),P<0.00001],实验组优于对照组;两组的皮片感染率有统计学差异[OR=0.10,95%CI(0.05,0.18),P<0.00001],实验组低于对照组;两组的平均住院时间有统计学差异[OR=-14.45,95%CI(-20.67,-8.23),P<0.00001],实验组少于对照组。结论:本研究表明在体表大面积皮肤缺损患者的治疗中VSD联合植皮与传统打包植皮比较,VSD联合植皮能提高皮片成活率、降低皮片感染率、减少患者平均住院时间。

Objective To assess the clinical effect of VSD combined with free skin graft in the treatment of large area skin defect comparing with traditional pressurized packaging technology. Methods Systematic literature research of Cochrane Library,Pubmed,CNKI and Wanfang Database.We chose ＂negative pressure vaccum drainage＂, ＂free skin graft＂, ＂large area skin defect＂ as keywords to search randomized controlled trials（RCTs）and controlled clinical trials（CCTs）of VSD combined with free skin graft versus traditional suppression of skin graft in the treatment of large area skin defect between Jan 2010 and Dec 2015,and retrieved the references of the included literature to prevent leak investigation.The methodological quality of the ultimately included studies was assessed comprehensively,and meta-analysis was implemented using the Cochrane Collaboration＇s software Rev Man 5.2. Results A total of 16 researches involved 1261 patients with large area skin defect,in the experimental group which included 715 patients,they take VSD negative pressure drainage technology combined with free skin graft,and the control group included 546 patients,they take traditional suppression of skin graft technology.A descriptive analysis of the results was presented： Compared with the skin graft survival,the experimental group and the control group had statistically significant difference[OR=7.77,95%CI（5.12,11.79）, P〈0.00001],and the experimental group was better than the control group.Compared with infection rate,the experimental group and the control group had statistically significant differen ce[OR=0.10,95%CI（0.05,0.18）, P〈0.00001],the experimental group was less than the control group.Compared with hospital days,the experimental group and the control group had statistically significant difference[OR=-15.89,95%CI（-17.08,-14.71）, P〈0.00001],the experimental group was less than the control group. Conclusion The results indicate that VSD negative pressure drainage technology combined with free skin graft in the treatment of large area skin defect can obviously improve the skin graft survival and reduce the infection rate and hospital days.