负压封闭引流联合皮瓣移植治疗慢性难愈性创面效果的Meta分析

Meta-Analysis of the Effect of Negative Pressure Closed Drainage Combined with Flap Transplantation in the Treatment of Chronic Refractory Wounds

摘要: 目的：系统评价负压封闭引流联合皮瓣移植应用于慢性难愈性创面的临床疗效。方法：计算机检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Web of Science、EMbase、The Cochrane Library等数据库，收集负压封闭引流联合皮瓣移植治疗慢性难愈性创面的随机对照试验(RCT)，检索时限均为建库至2023年3月1日。由两名研究者按照纳排标准独立检索文献，采用Cochrane协作网的评价工具对纳入的文献进行质量评价，使用Revman5.4软件进行图表绘制及分析。结果：共纳入9篇RCT，包括570例患者，其中，试验组288例，对照组282例。meta分析结果显示，与对照组相比，试验组可提高治疗总有效率[RR = 1.34, 95%CI (1.22, 1.47), P < 0.00001]、降低创面感染发生率[RR = 0.20, 95%CI (0.06, 0.68), P = 0.01]，缩短创面愈合时间[MD = −8.11, 95%CI (−11.32, −4.91), P < 0.00001]、缩短住院时间[MD = −9.52, 95%CI (−12.40, −6.64), P < 0.00001]。结论：负压封闭引流联合皮瓣移植在治疗慢性难愈性创面中有优越性，但受纳入研究质量和样本量的限制，今后可开展多中心、大样本的随机对照试验，进一步验证负压封闭引流联合皮瓣移植的应用效果。

Abstract: Objective: To systematically evaluate the clinical efficacy of negative pressure closed drainage combined with flap transplantation in chronic refractory wounds. Methods: The randomized controlled trial (RCT) of CNKI, Wanfang, VIP, CBM), PubMed, Web of Science, EMbase, The Cochrane Library and negative pressure closed drainage and flap graft transplantation for chronic difficult wounds were collected for the database until March 1, 2023. Two researchers independently searched the literature according to the size exclusion standard, evaluated the quality of the included literature, and graphed and analyzed using Revman5.4 software. Results: Of 9 RCTs were included, including 570 patients, including 288 patients in the test group and 282 patients in the control group. The results of the meta-analysis showed that, Compared with the control group, The test group can improve the total response rate [RR = 1.34, 95%CI (1.22, 1.47), P < 0.00001], reduce the incidence of wound infection [RR = 0.20, 95%CI (0.06, 0.68), P = 0.01], Shorten the wound healing time [MD = −8.11, 95%CI (−11.32, −4.91), P < 0.00001], shortened the length of stay [MD = −9.52, 95%CI (−12.40, −6.64), P < 0.00001]. Conclusion: The combination of negative pressure closure and drainage combined with flap transplantation has advantages in the treatment of chronic difficult wounds, but limited by the study quality and the sample size, a randomized controlled trial with multiple centers and large samples can be carried out in the future to further verify the application effect of negative pressure closure and drainage combined with flap transplantation.