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Short-term Results of a Randomized Controlled Trial Comparing Primary Suture With Primary Glued Mesh Augmentation to Prevent Incisional Hernia 背景：切口疝是腹部手术术后最常见的并发症之一。有腹主动脉瘤及体质指数（BMI)大于27的患者出现切口疝的风险更大。“网片加强”是一种加固腹壁降低腹壁切口疝发生率的方法。本研究是一个多中心双盲的随机对照试验，观察使用网片加固后预防腹正中切口疝发生的短期效果。 方法:选取2009年至2012年采取腹部正中切口手术的患者，并且患者有腹主动脉瘤或者体质指数大于27。患者随机分组，分别采用一期缝合，onlay网片加强（OMA）,sublay网片加强（SMA）。 结果：随访1个月，总共480名患者入组。血清肿发生率onlay网片加强组 18.1%（n=34），一期缝合组4.7%（n=5），sublay网片加强组7%（n=13）。但是其他结局如切口感染，血肿形成，再次手术，再次入院是没有差异的。多因素分析显示onlay网片加强血清肿形成率较高，与一期缝合的优势比为4.3（p=0.004），与膜sublay网片加强的优势比为2.9（p=0.003）。 结论：短期看来，网片加强是一种安全的预防切口疝的方法，与一期缝合相比，onlay网片加强（OMA）其发生血清肿的几率更高，但是并不会增加切口感染率。 原文标题和摘要： Short-term Results of a Randomized Controlled Trial Comparing Primary Suture With Primary Glued Mesh Augmentation to Prevent Incisional Hernia Background: Incisional hernia is one of the most frequent postoperative complications after abdominal surgery. Patients with an abdominal aortic aneurysm and patients with a body mass index of 27 or higher have an increased risk to develop incisional hernia. Primary mesh augmentation is a method in which the abdominal wall is strengthened to reduce incisional hernia incidence. This study focused on the short-term results of the PRImary Mesh Closure of Abdominal MidlineWounds trial, a multicenter double blind randomized controlled trial. Methods: Between 2009 and 2012 patients were included if they were operated via midline laparotomy, and had an abdominal aortic aneurysm or a body mass index of 27 or higher. Patients were randomly assigned to either receive primary suture, onlay mesh augmentation (OMA), or sublay mesh augmentation. Results: Outcomes represent results after 1-month follow-up. A total of 480 patients were randomized. During analysis, significantly (P = 0.002) more seromas were detected after OMA (n = 34, 18.1%) compared with primary suture (n = 5, 4.7%) and sublay mesh augmentation (n = 13, 7%). No differences were discovered in any of the other outcomes such as surgical site infection, hematoma, reintervention, or readmission. Multivariable analysis revealed an increase in seroma formation after OMA with an odds ratio of 4.3 (P = 0.004) compared with primary suture and an odds ratio of 2.9(P = 0.003) compared with sublay mesh augmentation. Conclusions: On the basis of these short-term results, primary mesh augmentation can be considered a safe procedure with only an increase in seroma formation after OMA, but without an increased risk of surgical site infection. Keywords: incisional hernia, onlay, prophylactic, primary mesh augmentation, sublay (Ann Surg 2015;261:276–281) |
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