中国实用外科杂志

中国实用外科杂志

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腹腔镜与开放式无张力疝修补术治疗成人复发性腹股沟疝疗效Meta分析

赵    健1，2，郭天康2   

  1. 1兰州大学第一临床医学院，甘肃兰州 730000；2甘肃省人民医院普外科，甘肃兰州 730000
  • 出版日期:2015-01-01 发布日期:2014-12-31

  • Online:2015-01-01 Published:2014-12-31

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摘要：

目的    评价腹腔镜与开放式无张力疝修补术治疗成人复发性腹股沟疝的临床疗效。 方法    计算机检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国学术期刊网全文数据库、中文科技期刊数据库和万方数据库，同时辅以其他检索。检索时间均从建库至2014年5月，语种不限。收集所有比较腹腔镜与开放式无张力疝修补术治疗成人复发性腹股沟疝的随机对照试验（RCTs）。由两名评价员独立按照纳入标准提取数据并交叉核对，采用Cochrane协作网推荐软件RevMan 5.2版进行统计分析。结果    最终纳入11个RCT,共1039例病人。Meta分析结果显示：与开放无张力组相比，腹腔镜技术在慢性疼痛（OR=0.40，95%CI：0.20~0.82，P=0.01）、切口感染率（OR=0.28，95%CI：0.10~0.81，P=0.02）、术后住院时间（国外：MD=-4.54，95%CI：-5.59~-3.49，P<0.00001；国内：MD=-2.46，95%CI：-2.83~-2.08，P<0.00001）和手术时间（MD=16.74，95%CI：14.69~18.80，P<0.00001）方面差异有统计学意义，而在术后再复发率（OR=0.73，95%CI：0.44~1.20，P=0.22）、急性疼痛（OR=0.74，95%CI：0.14~3.76，P=0.71）、血肿或血清肿（OR=0.73，95%CI：0.48~1.11，P=0.14）与尿潴留（OR=0.97，95%CI：0.46~2.07，P=0.94）方面差异无统计学意义。结论    与开放无张力手术相比，腹腔镜手术不可以降低术后再复发率但可以降低术后慢性疼痛与切口感染发生率；可以缩短术后住院时间但手术时间较长。两组在急性疼痛、血肿或血清肿与尿潴留方面的差异均无统计学意义。

关键词: 复发性腹股沟疝, 腹腔镜, 疝修补术, Meta分析

Abstract:

Laparoscopic compared with open Ten-Free methods of recurrent inguinal hernia repair in adults: A Meta analysis        ZHAO Jian, GUO Tian-kang.The First Hospital of Lanzhou University,Lanzhou 730000,China; Department of General Surgery, People’s Hospital of Gansu, Lanzhou 730000,China
Corresponding author：GUO Tian-kang，  E-mail：guotiankang59@126.com
Abstract    Objective    To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repair in adult recurrent inguinal hernia. Methods    We searched PubMed, EMbase, Cochrane Library, Web of Science and CBM, CNKI, VIP and Wanfang Database and supplemented by other searches in any language to collect the randomized controlled trials(RCTs) about the comparison of laparoscopic and open tension-free hernia repair in adult recurrent inguinal hernia published by May,2014.Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan5.2 software. Results    Eleven published reports of eligible studies involving 1039 participants met the inclusion criteria. Chronic pain（OR=0.40，95%CI：0.20~0.82，P=0.01）and wound infection rate（OR=0.28，95%CI：0.10~0.81，P=0.02）in the laparoscopic group were lower than the open tension-free, the postoperative hospital stay（Foreign：MD=-4.54，95%CI：-5.59~-3.49，P<0.00001，Domestic：MD=-2.46，95%CI：-2.83~-2.08，P<0.00001） was shorter in the laparoscopic group , but the longer operative time（MD=16.74，95%CI：14.69~18.80，P<0.00001）.The two groups had no significant differences in postoperative recurrence rate（OR=0.73，95%CI：0.44~1.20，P=0.22）,acute pain（OR=0.74，95%CI：0.14~3.76，P=0.71）,the hematoma/seroma（OR=0.97，95%CI：0.46~2.07，P=0.94）and urinary retention（OR=0.97，95%CI：0.46~2.07，P=0.94）. Conclusion    Current evidence suggested that the postoperative recurrence rate can’t reduce but the Chronic pain and wound infection rate can reduce in the laparoscopic group, and the laparoscopic group can reduce the postoperative hospital stay, but the operative time was longer. The difference between laparoscopic and open tension-free hernia repair in acute pain, hematoma/seroma and urinary retention areas were not statistically significant.

Key words: recurrent inguinal hernia, laparoscopic;hernia repair, Meta-analysis