轻量型补片和（中）重量型补片在开放式腹股沟疝无张力修补术后的疗效研究

发布时间：2018-07-17 19:41

【摘要】：目的:比较开放式腹股沟疝无张力修补术中,轻量型补片和(中)重量型补片的疗效和术后舒适度(如慢性疼痛、复发率、边缘牵扯感、不适感的发生率)。方法:回顾性研究2011年1月至2014年1月间在我科行腹股沟疝无张力修补术的患者共145例(152侧),随访率91.19%。研究分为轻量型补片组59例(60侧)和中量型补片组86例(92侧)。于术后3月、6月及12月行门诊和电话随访,对比分析两组患者手术前后的慢性疼痛、复发率、边缘牵扯感、舒适度等的发生率。进而,使用Meta分析,系统比较轻量型补片和重量型补片研究中的结果,采用的结局指标有,术后6个月,术后12个月时慢性疼痛,腹股沟区不适,异物感,以及总的复发率。结果:轻量型补片组和中量型补片组术后疝复发率分别为1.67%和1.09%(P=0.762)。在术后3月和6月,二组病例的疼痛发生率、疼痛程度、腹股沟区不适发生率、异物感发生率及边缘牵扯感发生率均无显著差异。术后1年时,轻量型补片组和中量型补片组的疼痛发生率(8.51%vs 12.50%)、异物感发生率(4.26%vs 12.50%)、VAS疼痛评分均值[(0.19±0.68)vs(0.21±0.71)]及边缘牵扯感(6.38%vs5.35%)均无显著性差异。但在术后腹股沟区不适发生率上,轻量型补片组为17.02%,显著优于中量型补片组的37.50%(P=0.021)。进而,行文献资料的分析和归纳。检索2000年-2014年的Pubmed,Ebsco,Embase,Web of Science数据库内相关文献。总共有10篇包含2322名患者的RCT文献适合于我们的Meta分析研究。在固定效应模型中,轻量型补片组和(中)重量型补片组复发率没有统计学差异[OR=1.34,95%CI(0.74~2.43),P=0.33]。根据孔径大小的差异大于或小于1mm,分为Group A和Group B,进一步的分层分析显示,在孔径大小差异大的亚组中,轻量型补片相较于重量型补片,在12个月慢性疼痛发生率上较低[OR=0.65,95%CI(0.47~0.90),P=0.01]。结论:轻量型补片在腹股沟疝无张力修补术的应用是安全有效,并且不增加术后复发率。1年期的随访结果显示轻量型补片组的腹股沟区不适发生率显著低于中量型补片组。相较于补片重量而言,网孔大小对开放式腹股沟疝修补术后慢性疼痛、腹股沟区不适、异物感方面或更具重要影响。
[Abstract]:Objective: to compare the efficacy and comfort of open tension-free inguinal hernia repair with light and (medium) weight patch (such as chronic pain, recurrence rate, marginal involvement and discomfort). Methods: a retrospective study of 145 cases (152 sides) of inguinal hernia tension-free repair from January 2011 to January 2014 was performed. The follow-up rate was 91.19. 59 cases (60 sides) and 86 cases (92 sides) were divided into two groups: light patch group (n = 59) and medium dose group (n = 86). After 3 months, 6 months and 12 months after operation, outpatient and telephone follow-up were performed to compare the incidence of chronic pain, recurrence rate, marginal involvement and comfort between the two groups before and after operation. Then, Meta-analysis was used to systematically compare the results of lightweight patch and weight patch. The outcome indexes were chronic pain, groin discomfort, foreign body sensation and total recurrence rate at 6 months after operation and 12 months after operation. Results: the recurrence rate of hernia was 1.67% and 1.09% in the light and medium dose group respectively (P0. 762). There was no significant difference in the incidence of pain, the degree of pain, the incidence of inguinal discomfort, the incidence of foreign body sensation and the incidence of marginal involvement between the two groups at 3 and 6 months after operation. There was no significant difference in the incidence of pain (8.51%vs 12.50%), foreign body sensation (4.26%vs 12.50%) and marginal involvement (6.38 vs 5.35%) in the light and moderate dose groups at 1 year after operation. The mean score of pain score was (0.19 卤0.68) vs (0.21 卤0.71) and the marginal involvement was (6.38 vs 5.35%). However, the incidence of postoperative discomfort in inguinal area was 17.022 in the light dose patch group, which was significantly higher than that in the medium dose patch group (37. 50%) (P0. 021). Then, the analysis and induction of the literature. To search the relevant literature in the Pubmedus Ebscobase Web of Science database from 2000 to 2014. A total of 10 RCT articles covering 2322 patients were suitable for our meta-analysis study. In the fixed effect model, there was no significant difference in the recurrence rate between the light dose patch group and the (middle) weight supplement group [ORA 1.34N 95 CI (0.742.43) Pao 0.33]. Group A and Group B were divided into Group A and Group B according to the difference of aperture size, and further stratification analysis showed that the incidence of chronic pain was lower in the subgroup with large difference in aperture size than that in the weight patch [OR0.65% 95% CI (0.470.90) P0.01]. Conclusion: the application of lightweight patch in inguinal hernia tension-free repair is safe and effective, and does not increase the recurrence rate. The results of 1-year follow-up showed that the incidence of inguinal discomfort in the light patch group was significantly lower than that in the moderate dose patch group. Compared with the weight of the patch, the size of the mesh may play a more important role in chronic pain, groin discomfort and foreign body sensation after open inguinal hernioplasty.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.21

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