目的比较荷包缝合与线性缝合皮肤在肠造口还纳术中的疗效。方法检索Embase、Pubmed、Web of Science、中国知网、万方数据库和维普中文科技期刊数据库公开发表的有关比较荷包缝合与线性缝合在肠造口还纳术中的文献。文献纳入标准:(1)公...目的比较荷包缝合与线性缝合皮肤在肠造口还纳术中的疗效。方法检索Embase、Pubmed、Web of Science、中国知网、万方数据库和维普中文科技期刊数据库公开发表的有关比较荷包缝合与线性缝合在肠造口还纳术中的文献。文献纳入标准:(1)公开发表的比较造口还纳术后荷包缝合与线性缝合腹部皮肤的随机对照试验(RCT)中英文文献;(2)研究对象为接受肠造口还纳术的患者,包括回肠、结肠造口还纳术,而且患者年龄、性别、种族不限;(3)荷包缝合组通过荷包缝合的方法缝合皮肤真皮层,收紧打结后皮肤中央可形成一个孔隙通道,以达到二期愈合的目的,线性缝合组使用常规单纯间断缝合法缝合皮肤;(4)纳入文献必须至少包含以下一项结局指标:主要结局指标为手术部位感染(SSI)发生率;次要结局指标包括手术时间、切口疝、住院时间和患者满意度。文献排除标准:(1)重复发表的研究以及信息提供不完整的研究;(2)综述、病例报告及未发表的文献;(3)回顾性研究、非RCT。检索时间截至2018年11月15日。提取纳入文章的基本信息与重要的结局指标,使用Cochrane偏倚风险评估工具对所选文献进行质量评价。使用以下量表评估患者的满意度:(1)患者和观察者瘢痕评估量表(POSAS);(2)身体形象调查问卷(BIQ);(3)李克特量表(Likert scale);(4)SF-36版本2(SF-36v2);(5)视觉模拟量表。采用Cochrane协作网提供的Review manager 5.3软件进行Meta分析。结果共纳入9项RCT文献,包括806例患者,其中荷包缝合组411例,线性缝合组395例。对纳入文献研究之间患者年龄、性别、体质指数(BMI)、基础疾病基线情况进行了比较,结果显示,两组基线资料比较差异无统计学意义(均P>0.05),具有可比性。纳入的9篇RCT质量评价均较高。由于各研究的评估形式不统一,无法对患者满意度进行Meta分析,但是从各项研究满意度汇总结果来看,荷包缝合组术后满意度较线性缝合组高。Meta分析结果显示:荷包缝合组与线性缝合组术后SSI发生率差异有统计学意义(OR=0.14,95%CI:0.08~0.24,P<0.001);但两组在切口疝发生率(OR=0.66,95%CI:0.24~1.82,P=0.42)、手术时间(MD=0.61,95%CI:-3.17~4.38,P=0.75)和住院时间(MD=-0.26,95%CI:-0.82~0.30,P=0.37)方面比较,差异均无统计学意义。结论肠造口还纳术中采用荷包缝合皮肤,与线性缝合相比,能够显著降低SSI发生率,患者满意度更高。展开更多
Objective： The use of fibrin adhesives has a broad background in nerve repair. Currently the suboptimal physical properties of singledonor fibrin adhesives have restricted their usage. The present experiment studies ...Objective： The use of fibrin adhesives has a broad background in nerve repair. Currently the suboptimal physical properties of singledonor fibrin adhesives have restricted their usage. The present experiment studies the performance and physical characteristics of a modified fibrin glue prepared from single-donor human plasma in the repair of posterior tibial nerve of rat. Methods： Forty Wistar rats were divided into 5 groups; in the control group, tibial nerve was completely transected and no treatment was done, while in the four experimental groups the nerve stumps were reconnected by one suture, three sutures, one suture with fibrin glue and fibrin glue alone respectively. During 8 weeks of follow-up, Tibial Function Index was measured weekly and adhesive strength, inflammation and scar formation were assessed at the end of the study. Results： Nerve stumps dehiscence rate and adhesive strength were similar in all experimental groups and significantly differed from control group （P〈0.05）. By the end of the eighth follow-up week, functional recovery of one and three sutures groups were significantly higher than groups in which fibrin glue was used for repair （P〈0.05）. The amount of inflammation and scar tissue formation was similar among all groups. Conclusion： The study results show that the prepared single-donor fibrin adhesive has acceptable mechanical properties which could provide required adhesiveness and hold nerve stumps in the long term; yet, we acknowledge that more studies are needed to improve functional outcome ofsinszle donor fibrin adhesive repair.展开更多
文摘Objective： The use of fibrin adhesives has a broad background in nerve repair. Currently the suboptimal physical properties of singledonor fibrin adhesives have restricted their usage. The present experiment studies the performance and physical characteristics of a modified fibrin glue prepared from single-donor human plasma in the repair of posterior tibial nerve of rat. Methods： Forty Wistar rats were divided into 5 groups; in the control group, tibial nerve was completely transected and no treatment was done, while in the four experimental groups the nerve stumps were reconnected by one suture, three sutures, one suture with fibrin glue and fibrin glue alone respectively. During 8 weeks of follow-up, Tibial Function Index was measured weekly and adhesive strength, inflammation and scar formation were assessed at the end of the study. Results： Nerve stumps dehiscence rate and adhesive strength were similar in all experimental groups and significantly differed from control group （P〈0.05）. By the end of the eighth follow-up week, functional recovery of one and three sutures groups were significantly higher than groups in which fibrin glue was used for repair （P〈0.05）. The amount of inflammation and scar tissue formation was similar among all groups. Conclusion： The study results show that the prepared single-donor fibrin adhesive has acceptable mechanical properties which could provide required adhesiveness and hold nerve stumps in the long term; yet, we acknowledge that more studies are needed to improve functional outcome ofsinszle donor fibrin adhesive repair.
