治疗成人腹股沟疝选择腹腔镜或开放Lichtenstein修补术——随机对照研究的Meta分析

Laparoscopic or open Lichtenstein repair of adult inguinal hernia:a meta-analysis with randomized controlled trials

目的:比较腹腔镜经腹腔腹膜前修补(transabdominal preperitoneal prosthetic TAPP)或腹腔镜完全腹膜外修补(to-tal extraperitoneal prosthetic,TEP)和开放Lichtenstein修补术治疗腹股沟疝的疗效与成本。方法:检索1990年1月至2004年12月31日PUDMED、EMBSE、MEDALINE、中国学术期刊网全文数据库收录的公开发表与研究目的相关的手术临床随机对照(RCTs)的研究文献,提取数据,满足条件者对数据进行合并分析,Meta分析软件用Revman4.2。评价指标包括:手术时间、围手术期总并发症、复发率和治疗费用。结果:有12个RCTs,1 763例患者纳入分析,腹腔镜组870例,其中TAPP 605例,TEP265例;开放Lichtenstein修补893例,Meta分析显示,腹腔镜手术比开放Lichtenstein手术的手术时间长。围手术期总并发症发生率相当。随访2-36个月,复发率相当。4项研究表明,腹腔镜组的手术费用较高。结论:目前证据提示,综合成本与疗效评价,原发的单侧腹股沟疝患者推荐采用Lichtenstein术式,复发双侧的腹股沟疝或有特殊要求的患者,腹腔镜手术可能是较好的选择。

Objective：To ten, pare the effectiveness and cost between lapar.scopic transabdominal preperitoneal repair （TAPP） or totally extraperitoneal repair（ TEl）） and open Lichtenstein repair for inguinal hernia. Methods：PUDMED, EMBSE, MEDALINE, CAJ FULL-TEXT DATABASE were used to search the published clinical randomized controlled trials （RCTs）about Lichtenstein repair and TEP or TAPP from 1990 to 2004. All the related data matched our standards were abstracted for Meta-analysis by Revman 4.2. The evaluation criteria included operation time, total perioperative complications, recurrence rate and treatment fee. Results：1 763 patients of 12 RCTs were included into the analysis. Among them 605 TAPP and 265 TEP were in laparoscopic group,945 patients were in open group. Meta-analysis showed operative duration was significantly longer in laparoscopic group. The overall perioperative complication rate and recurreace rate were relatively equal between the two operation procedures. But some of the studies showed laparoscopic repair needed high treatment fee and could bring some special complications. Conclusions： Open Lichtenstein repair is suitable for most patients for its significantly lower treatment fee, faster and easier operation skill, and can use local anesthesia been performed in day surgery clinieal practices, For the recurrence aud bilatcral inguinal hernia,laparoscopie repair may be a good choice.