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的Meta分析

发布时间：2018-07-16 09:41

【摘要】：目的:采用Meta分析评估腹腔镜与开放无张力疝修补术治疗成人复发性腹股沟疝的疗效及安全性。方法:从以下八大常用数据库进行相关文献的全面检索:PubMed、EMbase、Cochrane Library、Web of Science、生物医学、知网、维普和万方数据库,同时辅以其他检索方法,检索时间范围均限定于1990年1月至2014年5月,检索语种为中文和英文两种。收集所有对比两种不同手术方式治疗成人复发疝的疗效及安全性的随机对照试验(RCT)。由两名评价员按照纳入与排除标准独立进行文献筛选、资料提取并交叉核对,使用Cochrane协作网推荐软件Rev Man 5.3版本对数据实施统计分析。结果:最终纳入11篇RCT,共1039例病人。Meta分析结果显示:两种不同手术方法在腹股沟复发疝术后慢性疼痛发生率[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]、术后恢复日常活动时间[国外:MD=-4.54,95%CI(-5.59,-3.49),P0.00001,国内:MD=-2.24,95%CI(-2.55,-1.93),P0.00001]和手术时间[MD=4.57,95%CI(2.83,6.30),P0.00001]方面的差异有统计学意义,而在术后再复发率[OR=0.75,95%CI(0.46,1.21),P=0.24]、急性疼痛[OR=0.74,95%CI(0.14,3.76),P=0.71]、术后血肿或血清肿[OR=0.73,95%CI(0.48,1.11),P=0.14]与尿潴留发生率[OR=0.97,95%CI(0.46,2.07),P=0.94]方面的差异均无统计学意义。结论:与开放无张力手术相比,腹腔镜手术不仅可以降低腹股沟复发疝的术后慢性疼痛发生率与切口感染率,还可以缩短其术后恢复日常活动时间,但腹腔镜手术的手术时间较长。临床上可根据病人的具体情况及要求并结合临床医生的经验选择最优的再手术方法以取得良好的手术效果。
[Abstract]:Objective: to evaluate the efficacy and safety of laparoscopic and open tension-free hernioplasty for recurrent inguinal hernia in adults. Methods: the following eight common databases were used to conduct a comprehensive search for the following eight common databases: the Web of Science, Biomedicine, Web of knowledge, Weip and Wanfang databases, supplemented by other retrieval methods. The search time was limited from January 1990 to May 2014. The retrieval languages are Chinese and English. All randomized controlled trials (RCT) were conducted to compare the efficacy and safety of two different surgical procedures in the treatment of adult recurrent hernia. According to the criteria of inclusion and exclusion, two evaluators independently carried out literature screening, data extraction and cross-check, and used Cochrane Cooperative Network recommendation software Rev Man 5.3 to carry out statistical analysis of the data. Results: a total of 1039 patients with recurrent inguinal hernia were included in 11 RCTs. The results of Meta-analysis showed that two different surgical methods had a chronic pain rate after inguinal recurrent hernia [ORO 0.40% 95 CI (0.20 卤0.82) P0.01], incision infection rate [ORO 0.28995 CI (0.100.81) P0.02], postoperative recovery time of daily activities [foreign brain MD-4.54% 95 CI (-5.59% -3.49) P 0.00001]. There were statistically significant differences in the duration of operation between the two groups (-2.55U -1.93) and operation time (2.836.30 CI (2.836.30) P0.00001). However, there was no significant difference in the recurrence rate (0.75 卤95CI) (0.461.21), acute pain (0.143.76) CI (0.143.76) P0.71, postoperative hematoma or serum swelling (0.481.11 P0.14) and urinary retention rate (OR0.9795CI (0.462.07) P0.94). Conclusion: compared with open tension-free surgery, laparoscopic surgery can not only reduce the incidence of postoperative chronic pain and incision infection rate, but also shorten the time of daily recovery of postoperative activities in patients with recurrent inguinal hernia. But the operative time of laparoscopic surgery is longer. The optimal reoperation method can be selected according to the patient's specific condition and requirement and the clinician's experience in order to obtain good operation effect.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R656.21

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