Current Surgical Management of Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis.
Current Surgical Management of Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis.
复制标题
当前化脓性汗腺炎的外科治疗：系统回顾和荟萃分析。
作者：
Ashley O. Riddle;Linnea L Westerkam;C. Feltner;C. Sayed
背景
化脓性汗腺炎（HS）是一种慢性皮肤病，往往需要手术治疗。手术方法差异很大，疗效和安全性数据很少。
目的
从患者特征、手术入路和研究质量方面总结HS手术的文献。通过荟萃分析比较术后复发率。
方法
在PubMed、Embase和Scopus中检索2004年以后发表的关于外科HS管理的研究。对符合条件的研究进行复发率的随机效应荟萃分析。
结果
在715项确定的研究中，59项被纳入综述，33项被纳入荟萃分析。22项广泛切除研究的合并复发率最低，为8%（95%置信区间[CI] 2%-16%）;局部切除最高，为34%（95% CI 24%-44%）。对于广泛/根治性切除的研究，皮瓣修复的合并复发率最低，为0%（95% CI 0%-4%）;延迟一期缝合的复发率最高，为38%（95% CI 20%-59%）。
结论
广泛切除和皮瓣重建与术后HS复发率较低相关，尽管这必须与广泛手术的潜在较高发病率相平衡。证据的异质性和方法学局限性限制了对与手术技术相关的相对复发率做出强有力结论的能力。
登记
PROSPERO ID：CRD 42020159948。
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic dermatologic condition that often necessitates surgical treatment. Surgical approaches vary substantially with little data on efficacy and safety.
OBJECTIVE
Summarize the literature on HS surgery with regards to patient characteristics, surgical approaches, and study quality. Compare postsurgical recurrence rates with a meta-analysis.
METHODS
PubMed, Embase, and Scopus were searched for studies on surgical HS management published after 2004. A random effects meta-analysis of recurrence rates was performed on eligible studies.
RESULTS
Of 715 identified studies, 59 were included in the review and 33 in the meta-analysis. Twenty-two studies of wide excision had the lowest pooled recurrence rate at 8% (95% confidence interval [CI] 2%-16%); local excision had the highest at 34% (95% CI 24%-44%). For studies of wide/radical excision, flap repair had the lowest pooled recurrence rate at 0% (95% CI 0%-4%); delayed primary closure had the highest at 38% (95% CI 20%-59%).
CONCLUSIONS
Wide excision and flap-based reconstruction are associated with a lower postsurgical HS recurrence, although this must be balanced against potentially higher morbidity of extensive procedures. Heterogeneity and methodological limitations of the evidence limit the ability to make a strong conclusion about the relative recurrence rates associated with surgical techniques.
REGISTRATION
PROSPERO ID: CRD42020159948.