皮肤软组织扩张术治疗烧伤后瘢痕疗效与安全性的Meta分析

发布时间：2018-04-16 00:25

本文选题：皮肤软组织扩张 + 瘢痕　；参考：《吉林大学》2016年硕士论文

【摘要】：目的:皮肤软组织扩张术在临床整形修复外科中的应用,对于美容修复、皮肤软组织重建等均产生了巨大影响,皮肤软组织扩张器植入能提供较多高质量的额外皮肤,是一种高效、实用且更接近美学标准的组织修复方法。目前国内外相关研究较多,但相对样本均较小,本研究通过Meta分析来对比研究皮肤软组织扩张术与传统的复合皮移植术在治疗烧伤后瘢痕的有效性、安全性方面的差异,从而得到更客观和可靠的研究结果,以期为临床医生提供决策依据。方法:检索2000年1月至2016年9月公开发表的关于皮肤软组织扩张术与复合皮移植术治疗烧伤后瘢痕的随机对照试验(RCT)或临床对照试验(CCT)。检索的数据库包括Pub Med、EMBASE、CNKI、维普和万方数据库;按照制定好的纳入及排除标准对检索到的文献进行严格的筛选,并按照Cochrane系统评价手册对纳入的文献进行风险偏倚评估;按照预先设计好的表格独立提取数据,结局指标包括有效率、平均创面愈合时间、创面皮肤血运恢复时间及不良反应发生例数;应用由国际循证医学协作组提供的Rev Man 5.1软件对数据进行异质性检验和合并统计分析,二分类变量采用比值比(OR)、连续型变量采用均数差(MD)作为合并统计量,根据异质性检验结果选择相应模型进行合并统计分析;利用Rev Man 5.1进行漏斗图的绘制,并结合使用Stata13.0软件对发表偏倚进行Begg’s检验以判定发表偏倚的有无。结果:(1)本Meta分析共纳入16篇文献,均为中文;纳入的16篇文献中有三篇具有高风险偏倚,其余均为风险偏倚不明确;(2)报告有效率的文献共16篇,异质性检验P=0.990.05,表明各研究间同质,使用固定效应模型合并统计量,结果显示,OR合并(95%CI)为6.95(4.64,10.44),皮肤软组织扩张术组与复合皮移植术组治疗烧伤后瘢痕的有效性差异有统计学意义(Z=9.19,P0.01);(3)含平均创面愈合时间及创面皮肤血运恢复时间的4篇文献进行异质性检验,P=0.820.05,同质性较好,采用固定效应模型合并统计量,平均创面愈合时间合并结果显示,MD合并(95%CI)为-4.2(-4.93,-3.47),皮肤软组织扩张组与复合皮移植组平均创面愈合时间差异有统计学意义(Z=11.32,P0.01),创面皮肤血运恢复时间合并结果显示,MD合并(95%CI)为-5.35(-6.24,-4.46),皮肤软组织扩张术组与对照组血运恢复时间差异有统计学意义(Z=11.81,P0.01);(4)治疗的安全性方面,共有12篇文献报告了该指标,异质性检验发现,P=0.980.05,同质性较好,采用固定效应模型合并统计量,OR合并(95%CI)为0.33(0.29,0.49),皮肤软组织扩张组的总不良反应发生率明显少于复合皮移植组(Z=5.74,P0.01);(5)各指标发表偏倚结果显示,不存在发表偏倚(P0.5);敏感性分析显示,结果较为稳定。结论:皮肤软组织扩张术治疗烧伤后瘢痕有效性优于复合皮移植术,平均创面愈合时间及创面皮肤血运恢复时间短,且不良反应发生率较低,安全性较高,适于在烧伤后瘢痕修复中广泛使用;本研究纳入的16篇文献相对质量不高,但不存在发表偏倚且结果的稳定性较好。
[Abstract]:Objective: the application of skin soft tissue expansion in clinical plastic repair surgery, for cosmetic restoration, both had a huge impact on skin and soft tissue reconstruction, implantation of skin soft tissue expander can provide additional skin more high quality, is an efficient and practical method of tissue repair and closer to the aesthetic standards at home and abroad. More research, but relatively small samples, this research on comparative effectiveness study of skin soft tissue expansion with the traditional composite skin graft in the treatment of burn scar by Meta analysis, different security aspects, so as to get the results more objective and reliable, in order to provide decision-making basis for clinicians. Retrieval of randomized controlled trials on skin soft tissue expansion and composite skin transplantation in the treatment of burn scar in January 2000 and published in September 2016 (RCT) or clinical controlled trial Test (CCT). Search databases including Pub Med, EMBASE, CNKI, VIP and Wanfang database; according to the inclusion and exclusion criteria of the retrieved data were strictly screened out, and according to the Cochrane evaluation system manual for assessing the risk of bias of the included literature; in accordance with the pre designed data extraction form independent outcomes included, efficiency, the average time of wound healing, wound skin blood circulation recovery time and adverse reaction cases; application by the Cochrane Collaboration with Rev Man 5.1 software for data heterogeneity test and combined statistical analysis, two categorical variables using the odds ratio (OR), with continuous variables the mean difference (MD) as a combined statistics, according to the heterogeneity test results select the corresponding model combined with statistical analysis; 5.1 funnel plots using Rev Man, and combined use of Stata13.0 software Publication bias Begg 's test to determine whether the publication bias. Results: (1) the Meta analysis of 16 articles were included, are Chinese; in 16 articles and three articles with a high risk of bias, the rest are the risk of bias is not clear; (2) reported a total efficiency 16, test for heterogeneity between the studies show that P=0.990.05, homogeneous, using a fixed effects model with statistics. The results showed that with OR (95%CI) 6.95 (4.64,10.44), skin soft tissue expansion group and composite skin graft group after treatment of burn scar is effective and there was statistically significant difference (Z=9.19, P0.01) (3); 4 articles containing the average wound healing time and the recovery time of the wound skin blood test for heterogeneity, P=0.820.05, homogeneity, using fixed effect model with statistics, the average wound healing time and the results showed that with MD (95%CI) -4.2 (-4.93, -3.47) The skin, soft tissue expansion group and composite skin transplantation group the average wound healing time was statistically significant difference (Z=11.32, P0.01), the blood supply of skin wound recovery time with results showed that with MD (95%CI) -5.35 (-6.24, -4.46), the skin soft tissue expansion group and control group blood return time difference statistical significance (Z=11.81, P0.01); (4) the safety of treatment, a total of 12 articles reported the index, heterogeneity test, P=0.980.05, homogeneity, using fixed effect model combined with statistics, OR (95% CI) 0.33 (0.29,0.49), the occurrence of skin soft tissue expansion group total the rate of adverse reactions was significantly less than the composite skin transplantation group (Z=5.74, P0.01); (5) the index of publication bias showed that there was no evidence of publication bias (P0.5); the sensitivity analysis shows that the results are more stable. Conclusion: the surgical treatment of burn scar is better than the skin soft tissue expansion Composite skin transplantation, the average wound healing time and wound skin blood circulation and recovery time is short, and low incidence rate of adverse reaction, high safety, and is suitable for wide use in burn scar repair; 16 articles were included in the study of the relative quality is not high, but there are no published results on the partial stability and better.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R644

【参考文献】