皮肤软组织扩张术的临床应用及感染相关危险因素meta分析

发布时间：2018-06-28 04:51

本文选题：皮肤软组织扩张术 + 修复重建　；参考：《北京协和医学院》2017年硕士论文

【摘要】：背景:皮肤软组织扩张术是利用扩张器对皮肤软组织进行扩张,产生“额外”组织用于体表各部位缺损的修复重建。皮肤软组织扩张术发明至今已经历了 40余年的发展,随着扩张技术的变革、皮瓣血管解剖认识的加深、影像学技术的介入、干细胞移植技术的引入,扩张皮瓣朝向更大、更薄的方向发展,临床应用范围也随之扩大,现已用于全身各部位皮肤软组织缺损的修复,目前已成为整形外科的常规修复重建方法。但皮肤软组织扩张术具有治疗周期长、治疗经费开销大、相关并发症发生率较高等不足之处。常见并发症有感染、血肿、切口开裂、皮肤坏死等。并发症的不良预后阻碍了扩张器进一步的发展与应用,尤其是感染并发症对最终皮肤修复成功与否有极大影响。目前,对皮肤软组织扩张器感染并发症的相关危险因素进行meta分析尚未见报道。目的:本研究旨在通过meta分析,合并既往研究结果数据,通过较大样本量来验证与皮肤软组织扩张器感染密切相关的危险因素,为一线工作的临床医师提供参考数据以及一级预防的相关资料,尽可能降低感染的发生率,进而提高治疗效果。资料与方法:通过对Pubmed、Cochrane Library、Embase、中国知网以及万方医学网数据库进行文献检索,对从1986年至2016年已发表的相关文献进行归纳整理。按照一定的纳入、排除标准,选择符合要求的文献,采用meta分析进行定量分析,分析皮肤软组织扩张器感染的相关危险因素。结果:最终纳入17篇1992-2006年间发表的回顾性观察性研究,其中包含8280例患者。对所选文献中软组织扩张器感染相关危险因素进行分析。扩张器埋置部位(四肢)、局部瘢痕、注水阀门外置、吸烟、肥胖、糖尿病、放疗相对危险比可信区间大于1,具有统计学意义。提示这些因素与皮肤软组织扩张器感染发生存在明显的相关性。结论:扩张器埋置部位(四肢)、局部瘢痕、注水阀门外置、吸烟、肥胖、糖尿病、放疗等危险因素可能增加皮肤软组织扩张器感染的发生。本系统回顾研究与荟萃分析为临床工作的一线医师提供了关于皮肤软组织扩张器感染的相关危险因素的有利证据。
[Abstract]:Background: skin and soft tissue dilatation is the use of dilator to expand the skin and soft tissue, resulting in "extra" tissue for the repair and reconstruction of defects in various parts of the body surface. The development of skin and soft tissue expansion has gone through more than 40 years. With the development of expansion technique, the understanding of vascular anatomy of skin flap, the intervention of imaging technology, the introduction of stem cell transplantation, the expansion of skin flap towards a larger direction. With the development of thinning, clinical application has been expanded, which has been used to repair skin and soft tissue defects in various parts of the body, and has become the conventional method of plastic surgery. However, skin and soft tissue dilatation has many disadvantages, such as long treatment cycle, high cost and high incidence of complications. Common complications include infection, hematoma, incision cracking, skin necrosis and so on. The poor prognosis of complications hinders the further development and application of dilators, especially the infection complications have a great impact on the success of the final skin repair. At present, meta analysis of risk factors related to complications of skin and soft tissue dilator infection has not been reported. Objective: to investigate the risk factors associated with skin and soft tissue dilatator infection by meta analysis and data from previous studies. In order to reduce the incidence of infection and improve the therapeutic effect, the reference data and the related data of primary prevention are provided for the clinicians working on the first line. Materials and methods: through the literature retrieval of Pubmedan Cochrane Library Embase, China knowledge Network and Wanfang Medical Network, the relevant literatures published from 1986 to 2016 were summarized and sorted out. According to certain inclusion, exclusion criteria, selected documents that meet the requirements, meta analysis was used for quantitative analysis to analyze the risk factors of skin and soft tissue dilator infection. Results: 17 retrospective observational studies published between 1992 and 2006 were included, including 8280 patients. The risk factors associated with soft tissue dilator infection in selected literature were analyzed. The relative risk of dilatator (limb), local scar, water injection valve, smoking, obesity, diabetes, and radiotherapy were higher than 1, which was statistically significant. These results suggest that there is a significant correlation between these factors and the occurrence of skin soft tissue dilator infection. Conclusion: the risk factors of dilator implantation (limb), local scar, water injection valve placement, smoking, obesity, diabetes, radiotherapy and other risk factors may increase the occurrence of skin and soft tissue dilator infection. This systematic retrospective study and meta-analysis provide clinical first-line physicians with useful evidence on the risk factors associated with skin and soft tissue dilatator infection.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

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