永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析

A meta-analysis of prophylactic mesh placement during permanent colostomy on the prevention of parastomal hernia

目的系统评价永久性结肠造口时预防性应用补片对造口旁疝预防作用的安全性及有效性。方法检索自建库至2021年7月发表于英文数据库(PubMed、Science Citation Index、Cochrane、EMBASE)及中文数据库(知网、万方、维普及中国生物医学文献数据库)有关永久性结肠造口同时置入补片的随机对照研究。文献质量评价及提取资料由2名研究员独立进行。数据采用Stata 13及Revman 5.3软件进行分析。结果共纳入14项随机对照研究,共计患者1280例,其中补片组(接受预防性置入补片)625例,对照组(未接受补片置入)655例。Meta分析显示补片组较对照组造口旁疝发生率(RR=0.49,95%CI 0.37~0.64,P<0.00001)降低,且造口旁疝需手术修复发生率(RR=0.25,95%CI 0.13~0.51,P=0.0001)降低。补片组及对照组造口相关感染(RR=0.90,95%CI 0.38~2.13,P=0.81)、造口坏死(RR=0.76,95%CI 0.41~1.43,P=0.40)、造口回缩(RR=1.42,95%CI 0.55~3.64,P=0.47)、造口皮肤黏膜分离(RR=1.21,95%CI 0.64~2.30,P=0.56)、造口脱垂(RR=0.46,95%CI 0.21~1.05,P=0.06)、造口狭窄(RR=1.31,95%CI 0.62~2.79,P=0.48)发生率比较,差异均无统计学意义。结论预防性置入补片可预防结肠造口术后造口旁疝的发生,是安全可行的,但仍需开展高质量、大样本的研究来论证该结论。

Objective To systematically evaluate the safety and efficacy of prophylactic mesh placement during permanent colostomy in preventing parastomal hernia(PSH).Methods A systematic search of English database(PubMed,Science Citation Index,Cochrane,EMBASE)and Chinese database(CNKI,Wanfang,VIP and CBM)was conducted for randomized controlled trials(RCTs)concerning prophylactic mesh placement during permanent colostomy for prevention of PSH,which published from the establishment of the database to July 2021.Two independent investigators evaluated the quality of the included literature and extracted data.Data were analyzed using Stata 13 and Revman 5.3 software.Results A total of 14 RCTs involving 1280 patients were included.There were 625 patients in the mesh group(who received prophylactic mesh placement)and 655 patients in the control group(who did not receive mesh placement).The results of meta-analysis revealed that prophylactic mesh group had lower incidence of PSH(RR=0.49,95%CI 0.37-0.64,P<0.00001)and lower incidence of PSH requiring repair(RR=0.25,95%CI 0.13-0.51,P=0.0001)than those in the control group.There were no statistically difference between mesh group and control group for the incidence of stoma related infection(RR=0.90,95%CI 0.38-2.13,P=0.81),stomal necrosis(RR=0.76,95%CI 0.41-1.43,P=0.40),stomal retraction(RR=1.42,95%CI 0.55-3.64,P=0.47),stoma skin and mucosa dehiscence(RR=1.21,95%CI 0.64-2.30,P=0.56),stoma prolapse(RR=0.46,95%CI 0.21-1.05,P=0.06)and stoma stenosis(RR=1.31,95%CI 0.62-2.79,P=0.48).Conclusion Prophylactic mesh placement during permanent colostomy can prevent PSH after surgery,which is a safe and feasible method,but further high-quality and large sample studies are still required to verify the conclusion.