生物补片与合成补片在腹壁疝修补术中风险与效益评估的meta分析

Risk and benefit evaluations of biological versus synthetic mesh for ventral hernia repair:a meta-analysis

目的系统评价生物补片与不可吸收合成补片对腹壁疝修补术后复发、并发症风险及成本效益的影响。方法检索PubMed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、CNKI、万方和维普数据库中公开发表的相关研究,检索时间从建库至2021年8月1日,按纳入和排除标准筛选文献并提取数据,对满足条件的数据进行meta合并分析,分析软件用RevMan5.4.1。结果本研究纳入了26项研究共3259例患者,其中生物补片组1388例,合成补片组1871例。meta分析结果显示,生物补片组术后复发、手术部位感染、手术部位事件、再手术发生率及医疗成本均高于合成补片组(P<0.05),而2组间补片感染、血清肿、血肿、伤口裂开、再入院发生率比较差异均无统计学意义(P>0.05)。结论腹壁疝修补术中合成补片在对术后复发、手术部位感染、手术部位事件、再手术等方面优于生物补片且可降低医疗成本,未来可尝试在清洁污染、污染环境等复杂腹壁疝患者中更多地使用合成补片。

Objective To systematically evaluate the effects of biological mesh(BM)and non-absorbable synthetic mesh(SM)on the risks of recurrence,complications,and cost-effectiveness after ventral hernia repair.Methods The publicly published related researches of BM versus SM for ventral hernia repair were searched in the PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang,VIP,CBM databases from the establishment of the databases to August1,2021.According to the inclusion and exclusion criteria,the literatures were screened and the data were extracted,and the data that met the conditions were merged and analyzed.The meta-analysis was performed by RevMan5.4.1 software.Results A total of 26 studies with 3259 patients were included,including 1388 patients in the BM group and 1871 in the SM group.The results of meta-analysis showed that the recurrence,surgical site infection,surgical site occurrence,reoperation rates,and medical costs in the BM group were higher than those in the SM group(P<0.05).There were no significant differences in the patch infection,seroma,hematoma,wound dehiscence,and readmission rates between the two groups(P>0.05).Conclusions SM during ventral hernia repair is better than BM on postoperative recurrence,surgical site infection,surgical site occurrence,reoperation,etc.,and could reduce medical costs.In the future,it is tried to use more SM in patients with complicated ventral hernia such as cleaning pollution and contaminated environment.