儿童腹股沟疝腹腔镜术与开放性手术疗效和安全性的Meta分析

Efficacy and safety between laparoscopic and open surgery of pediatric inguinal hernia:a meta-analysis

目的比较腹腔镜术与开放性手术治疗儿童腹股沟疝的疗效和安全性。方法计算机检索PubMed、EMBASE、Cochrane图书馆、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库和万方数字化期刊群,检索时间均从建库至2010年3月。纳入有关腹腔镜术与开放性手术治疗儿童腹股沟疝的RCT文献,根据CochraneHandbook5.0.2质量评价标准评价纳入文献的质量。评价两种术式的手术持续时间、术后总并发症的发生率、腹股沟疝的复发率、术后恢复日常活动时间和术中出血量。采用RevMan5.0软件对数据进行定量合并。结果最终纳入5篇RCT文献(共纳入586例患儿)。2篇文献被评为B级,3篇文献被评为C级。Meta分析结果显示,与开放性手术相比,腹腔镜术可减少术中出血量(MD=-1.35,95%CI:-1.80^-0.90,P<0.00001),但延长了单侧腹股沟疝的手术持续时间(MD=10.23,95%CI:4.33~16.14,P=0.0007),不能降低腹股沟疝的复发率(RR=0.51,95%CI:0.15~1.73,P=0.28)和术后总并发症的发生率(RR=0.16,95%CI:0.02~1.49,P=0.11),不能缩短术后恢复日常活动时间(SMD=-0.19,95%CI:-0.49~0.11,P=0.21)。结论腹腔镜术与开放性手术相比,可减少术中出血量,不增加腹股沟疝的复发率和术后总并发症的发生率,但不能缩短术后恢复日常活动时间,延长了单侧腹股沟疝的手术持续时间。鉴于纳入文献的总体质量偏低,应开展设计良好的RCT研究提供更高级别的证据。

Objective To compare the efficacy and safety between laparoscopic and open surgery of pediatric inguinal hernia.Methods All RCTs about laparoscopic and open surgery of pediatric inguinal hernia were searched from PubMed,Cochrane Library,EMBASE,Chinese Biomedical Literature Database,Chinese Science and Technology Academic Journal,China Academic Journal and Wanfang（from establishment to March 2010）,to assess operative time（unilateral）,intraoperative blood loss,total postoperative complications,recurrence rate of inguinal hernia and time to resume normal daily activities after surgery.The quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2.Results Five RCTs（586 patients）were included.Two RCTs were graded B,3 were graded C.Compared with open surgery,laparoscopic surgery decreased intraoperative blood loss（MD=-1.35,95%CI：-1.80--0.90,P〈0.000 01）,but it extended operation time of unilateral inguinal hernia（MD=10.23,95%CI：4.33-16.14,P=0.000 7）.However,laparoscopic surgery could not lower the recurrence rate of inguinal hernia（RR=0.51,95%CI：0.15-1.73,P=0.28）and total postoperative complications（RR=0.16,95%CI：0.02-1.49,P=0.11）,and aslo could not shorten the time to resume normal daily activities after surgery（SMD=-0.19,95%CI：-0.49-0.11,P=0.21）.Conclusions The current evidence shows that laparoscopic surgery reduce intraoperative blood loss,and can not increase the recurrence rate or total postoperative complications,but can not shorten recovery time.On the contrary,it extends operative time of unilateral inguinal hernia.