腹腔镜与开放式无张力疝修补术治疗成人腹股沟疝疗效的系统评价

Laparoscopic Compared with Open Methods of Groin Hernia Repair in Adults:A Systematic Review of Clinical Controlled Trials

目的评价腹腔镜与开放式无张力修补术治疗成人腹股沟疝的临床疗效。方法计算机检索2002～2009年9月期间的PubMed、EMbase、Cochrane图书馆临床对照试验资料库(2009年第3期)、中国生物医学文献数据库(CBM)、中国学术期刊网全文数据库(CNKI)和维普中文科技期刊数据库。检索语种不限。纳入比较腹腔镜与开放式无张力疝修补术治疗成人腹股沟疝的随机或半随机对照试验,并观察两种手术方法的术后慢性疼痛、远期复发率、术中术后并发症发生率。由两名评价员独立按照纳入标准提取数据并交叉核对,依据Cochrane handbook 5.0.2推荐的"偏倚风险评估"工具对纳入研究进行风险偏倚评估。采用Cochrane协作网推荐软件RevMan 5.0版进行统计分析。结果最终纳入18个试验,共5 816例。Meta分析结果显示:腹腔镜与开放式疝修补术相比较,两者在远期复发率[OR=1.53,95%CI(1.00,2.34),P=0.05]、术后并发症发生率[OR=0.74,95%CI(0.52,1.05),P=0.09]方面差异均无统计学意义。但两者在慢性持续性疼痛[OR=0.45,95%CI(0.34,0.59),P<0.000 01]、术中并发症发生率[OR=2.15,95%CI(1.32,3.53),P=0.002]方面的差异有统计学意义。结论本研究结果提示,腹腔镜疝修补术在降低慢性疼痛的发生方面优于开放式无张力疝修补术,远期复发率和术后并发症方面没有差异。术中并发症和其它术后远期并发症尚需进一步研究。

Objective To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adults.Methods A fully recursive literature search was conducted in PubMed（2002 to September,2009）,EMBASE（2002 to September,2009）,Cochrane Central Register of Controlled Trials（Issue 3,2009）,CBM（2002 to September,2009）,CNKI and VIP Chinese Scientific Journals Full-text Database（2002 to September,2009） in any language.Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adults were considered for inclusion.The four analyzed outcome variables were chronic pain,long term recurrence,intraoperative complications and postoperative complication.Data related to clinical outcomes were extracted by two reviewers independently.Statistical analyses were carried out using RevMan 5.0 so ware.Results Eighteen published reports of eligible studies involving 5816 participants met the inclusion criteria.Compared with open methods,laparoscopic inguinal hernia had no significant differences in long-term recurrence rate [OR 1.53,95%CI（1.00 to 2.34）,P=0.05] and postoperative complication rate [OR 0.74,95%CI（0.52 to 1.05）,P=0.09],and had lower tendency chronic pain [OR 0.45,95%CI（0.34 to 0.59）,P0.000 01] with statistical signi cance.ere were signi cant differences in intraoperative complications between the two groups [OR 2.15,95%CI（1.32 to 3.53）,P=0.002].Conclusion Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain.There is no significant difference in long-term recurrence rate and postoperative complications between the two methods.More studies are needed for intraoperative complications and other long-term postoperative complications.