据报道，因克罗恩病 (CD) 进行直肠切除术后，会阴伤口不愈合很常见。我们对 CD 直肠切除术后会阴伤口愈合进行了系统回顾和荟萃分析，并评估了不愈合的危险因素。在 PubMed、Embase 和 Scopus 数据库中对 2010 年至 2023 年报告会阴伤口愈合的文章进行了全面的文献检索包括 CD 直肠切除术后的发生率。提取了有关研究特征、愈合伤口比例以及危险因素的数据。使用 R 中的“meta”包进行随机效应荟萃分析来估计合并比例和 95% CI。使用 I2 统计量评估异质性。我们确定了 501 篇文章，其中 252 篇在重复数据删除后仍保留。筛选后，纳入了 4 项回顾性队列研究，涉及 333 名患者。在这 4 项研究中，6 个月时会阴伤口完全愈合的汇总比例为 65%（95% CI 52%-80%），12 个月时为 70%（95% CI 60%-83%）。研究之间存在显着异质性（6 个月时 I2 = 86%）。三项研究探讨了直肠切除术后愈合受损的危险因素。一项研究通过多变量分析确定术前会阴脓毒症是与愈合受损相关的唯一独立因素 (P = .001)。在一项研究中，单变量分析显示，男性、从转流到直肠切除术的时间较短以及术前较高的 C 反应蛋白水平均与延迟愈合相关。另一项研究发现，近距离直肠切除的治愈率显着低于全直肠系膜切除（P = .01）。既往使用肿瘤坏死因子抑制剂与伤口愈合结果无关。这项荟萃分析显示，CD 直肠切除术后 12 个月，只有 70% 的患者会阴完全愈合。这凸显了知识差距，包括确定可改变的危险因素以及预防或挽救治疗的方法，例如针对 CD 直肠切除术后不愈合的会阴伤口的真空辅助闭合和皮瓣重建。会阴伤口愈合结果不佳可能与 CD 患者对潜在炎症失调和全身性伤口愈合受损的了解不完全有关。© 作者 2024。由牛津大学出版社代表克罗恩病出版

Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing.A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic.We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes.This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD.© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.