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

doi:10.3877/cma.j.issn.1674-392X.2024.03.020

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 336 -342. doi: 10.3877/cma.j.issn.1674-392X.2024.03.020

循证医学

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

朱俊佳¹, 孙琦², 徐文龙², 陆天宇², 冯强², 储涛², 邢春根³, 高春冬², 俞一峰², 赵振国²^,^†(

)

^1. 214400　江苏省江阴市人民医院肛肠外科；215004　江苏，苏州大学附属第二医院胃肠外科
^2. 214400　江苏省江阴市人民医院肛肠外科
^3. 215004　江苏，苏州大学附属第二医院胃肠外科

收稿日期:2023-01-24 出版日期:2024-06-18
通信作者: 赵振国
基金资助:
无锡市卫生健康委员会青年科研项目基金(Q201949); 江阴市中青年卫生人才项目(JYOYT202304); 无锡市卫健委科技成果与适宜技术推广项目(TG202312)

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

Junjia Zhu¹, Qi Sun², Wenlong Xu², Tianyu Lu², Qiang Feng², Tao Chu², Chungen Xing³, Chundong Gao², Yifeng Yu², Zhenguo Zhao²^,^†()

^1. Department of Anorectal Surgery, Jiangyin People's Hospital, Wuxi 214400, Jiangsu Province, China; Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
^2. Department of Anorectal Surgery, Jiangyin People's Hospital, Wuxi 214400, Jiangsu Province, China
^3. Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China

Received:2023-01-24 Published:2024-06-18
Corresponding author: Zhenguo Zhao

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引用本文：

朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 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[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.

Junjia Zhu, Qi Sun, Wenlong Xu, Tianyu Lu, Qiang Feng, Tao Chu, Chungen Xing, Chundong Gao, Yifeng Yu, Zhenguo Zhao. A meta-analysis of prophylactic mesh placement during permanent colostomy on the prevention of parastomal hernia[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 336-342.

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<0.000 01）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。

关键词: 造口旁疝, 预防, 补片, 随机对照研究, Meta分析

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<0.000 01) 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.

Key words: Parastomal hernia, Prophylaxis, Mesh, Randomized controlled trial, Meta analysis

图1 文献筛选流程图

表1 纳入文献基本特征

作者	年份	国家	样本量(例,M/C)	手术方式	补片位置	性别(男性∶女性,M/C)	年龄(岁,M/C)	BMI (kg/m²,M/C)	随访时间(月)	诊断方式
Jänes	2009	瑞典	27:27	开腹	Sublay	15:12/16:11	70/71	26/27	65.2	临床
Serra-Aracil	2009	西班牙	27:27	开腹	Sublay	19:5/16:8	67.5/67.2	25.6/27.3	29(中位)	临床及CT
Lo´pez-Cano	2012	西班牙	19:17	腹腔镜	IPOM	11:8/7:10	72.2/65.9	26.3/27.5	12	CT
Târcoveanu	2014	罗马尼亚	20:22	开腹	Sublay	-	-	-	20(中位)	临床及超声
Brandsma	2016	荷兰	72:78	开腹	Sublay	43:29/49:29	63.5/63	26.8/26.5	12.4	临床及CT
Lambrecht	2015	挪威	32:26	开腹	Sublay	22:10/21:5	64/63	-	40(中位)	临床及CT
López-Cano	2016	西班牙	24:28	腹腔镜	IPOM	21:3/16:8	70.5/67.3	25.3/26.9	26(中位)	CT
Odensten	2019	瑞典	114:118	开腹	Sublay	74:40/62:56	69.7/69.9	26.1/26.3	12	临床及CT
Makarainen-Uhlback	2020	芬兰	37:38	腹腔镜	IPOM	18:17/19:16	67.1/65.1	26.2/25.4	65(中位)	临床及CT
Marinez	2020	瑞典、丹麦	63:74	开腹及腹腔镜	Sublay	42:21/43:31	68/72	26.3/24.7	12	CT
Prudhomme	2020	法国	98:101	开腹及腹腔镜	Sublay	57:41/57:44	67.2/70.5	25.6/24.8	24	临床、CT及MRI
崔冀	2009	中国	30:30	开腹	IPOM	-	-	-	36	临床、CT及超声
袁炜嗣	2016	中国	41:41	腹腔镜	IPOM	26:15/20:21	65/65	22.4/23.6	12	临床及CT
饶敏	2019	中国	21:28	腹腔镜	Onlay	11:10/16:12	66.5/63.8	21.8/22.3	36	CT

表1 纳入文献基本特征

作者	年份	国家	样本量(例,M/C)	手术方式	补片位置	性别(男性∶女性,M/C)	年龄(岁,M/C)	BMI (kg/m²,M/C)	随访时间(月)	诊断方式
Jänes	2009	瑞典	27:27	开腹	Sublay	15:12/16:11	70/71	26/27	65.2	临床
Serra-Aracil	2009	西班牙	27:27	开腹	Sublay	19:5/16:8	67.5/67.2	25.6/27.3	29(中位)	临床及CT
Lo´pez-Cano	2012	西班牙	19:17	腹腔镜	IPOM	11:8/7:10	72.2/65.9	26.3/27.5	12	CT
Târcoveanu	2014	罗马尼亚	20:22	开腹	Sublay	-	-	-	20(中位)	临床及超声
Brandsma	2016	荷兰	72:78	开腹	Sublay	43:29/49:29	63.5/63	26.8/26.5	12.4	临床及CT
Lambrecht	2015	挪威	32:26	开腹	Sublay	22:10/21:5	64/63	-	40(中位)	临床及CT
López-Cano	2016	西班牙	24:28	腹腔镜	IPOM	21:3/16:8	70.5/67.3	25.3/26.9	26(中位)	CT
Odensten	2019	瑞典	114:118	开腹	Sublay	74:40/62:56	69.7/69.9	26.1/26.3	12	临床及CT
Makarainen-Uhlback	2020	芬兰	37:38	腹腔镜	IPOM	18:17/19:16	67.1/65.1	26.2/25.4	65(中位)	临床及CT
Marinez	2020	瑞典、丹麦	63:74	开腹及腹腔镜	Sublay	42:21/43:31	68/72	26.3/24.7	12	CT
Prudhomme	2020	法国	98:101	开腹及腹腔镜	Sublay	57:41/57:44	67.2/70.5	25.6/24.8	24	临床、CT及MRI
崔冀	2009	中国	30:30	开腹	IPOM	-	-	-	36	临床、CT及超声
袁炜嗣	2016	中国	41:41	腹腔镜	IPOM	26:15/20:21	65/65	22.4/23.6	12	临床及CT
饶敏	2019	中国	21:28	腹腔镜	Onlay	11:10/16:12	66.5/63.8	21.8/22.3	36	CT

图2 纳入随机对照研究的质量评价表

图3 补片组与对照组的meta分析森林图注：3A造口旁疝总体发生率；3B造口旁疝临床查体诊断发生率；3C造口旁疝影像学诊断发生率；3D造口旁疝需手术修复发生率。

表2 补片组与对照组相关并发症Meta分析汇总

并发症	研究数目	研究例数	发生例数		RR(95% CI)	I²[%]	P值
并发症	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	P值
造口相关感染	7	637	9	10	0.90(0.38~2.13)	0	0.81
造口坏死	8	748	14	19	0.76(0.41~1.43)	0	0.40
造口回缩	4	374	9	6	1.42(0.55~3.64)	0	0.47
造口皮肤黏膜分离	6	464	17	14	1.21(0.64~2.30)	0	0.56
造口脱垂	5	426	7	15	0.46(0.21~1.05)	0	0.06
造口狭窄	8	670	14	10	1.31(0.62~2.79)	0	0.48

表2 补片组与对照组相关并发症Meta分析汇总

并发症	研究数目	研究例数	发生例数		RR(95% CI)	I²[%]	P值
并发症	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	P值
造口相关感染	7	637	9	10	0.90(0.38~2.13)	0	0.81
造口坏死	8	748	14	19	0.76(0.41~1.43)	0	0.40
造口回缩	4	374	9	6	1.42(0.55~3.64)	0	0.47
造口皮肤黏膜分离	6	464	17	14	1.21(0.64~2.30)	0	0.56
造口脱垂	5	426	7	15	0.46(0.21~1.05)	0	0.06
造口狭窄	8	670	14	10	1.31(0.62~2.79)	0	0.48

表3 亚组分析

亚组分析	研究数目	研究例数	造口旁疝发生例数		RR(95% CI)	I²[%]	组间差异P值
亚组分析	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	组间差异P值
补片位置
Sublay	8	773	90	156	0.53(0.35,0.78)	60	0.70
Onlay	1	39	4	13	0.36(0.14,0.91)	-
IPOM	5	298	33	83	0.45(0.33,0.62)	7
手术方式
开腹	7	581	52	110	0.35(0.17,0.69)	70	0.49
腹腔镜	5	277	37	88	0.45(0.34,0.60)	0	0.49

表3 亚组分析

亚组分析	研究数目	研究例数	造口旁疝发生例数		RR(95% CI)	I²[%]	组间差异P值
亚组分析	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	组间差异P值
补片位置
Sublay	8	773	90	156	0.53(0.35,0.78)	60	0.70
Onlay	1	39	4	13	0.36(0.14,0.91)	-
IPOM	5	298	33	83	0.45(0.33,0.62)	7
手术方式
开腹	7	581	52	110	0.35(0.17,0.69)	70	0.49
腹腔镜	5	277	37	88	0.45(0.34,0.60)	0	0.49

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

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