重量型补片与轻量型补片应用于腹股沟疝修补术的Meta分析

A Meta-Analysis of comparing lightweight mesh with heavyweight mesh in inguinal hernia repair

目的评价重量型补片与轻量型补片应用于腹股沟疝无张力修补对患者恢复的影响。方法检索PubMed、EMBase、Springer及Cochrane图书馆,结合查找到文献中的参考文献,检索时间从2000年1月至2010年9月,选择有关重量型补片与轻量型补片应用于腹股沟疝修补术的临床对照研究,由两位作者分别对研究质量进行评估,并提取有关资料,主要包括术后复发、血肿与血清肿、异物感,感染及疼痛的情况,采用RevMan5.0软件进行Meta分析。结果共纳入21项临床对照研究,其中16项为前赡性随机对照临床研究,包括5389例,其中重量型补片组2861例,轻量型补片组2528例。对纳入研究进行整体分析显示,轻量型补片组术后异物感发生率明显少于重量型补片组(p<0.05),优势比(Odds ratio)及95%可信区间为1.90(1.48,2.43),轻量型补片组术后慢性疼痛(12个月或更长)的发生率明显少于重量型补片组(p<0.05),OR及95%可信区间为1.39(1.10,1.75);两组患者在术后的复发、血肿(血清肿)、感染及早期疼痛的发生率无显著差异(p>0.05)。结论使用轻量型补片进行腹股沟疝无张力修补术,能减少术后的异物感及慢性疼痛,对术后的复发、血肿(血清肿)、感染及早期疼痛无明显影响。

Objective To evaluate the influence of the lightweight mesh and heavyweight mesh on postoperative recovery in tension free inguinal hernia repair.Methods Pubmed,EMBase,Springer and the Cochrane Controlled Trials Register were searched to identify all clinical case-controls published from Jan.2000 to Sep.2010 which compared lightweight mesh with heavyweight mesh used in inguinal repair.The studies listed at the end of these articles as reference were also searched.Two authors independently assessed the quality of each study to meet the inclusion criteria and extracted data,including postoperative hernia recurrence,seroma or hematoma,foreign body sensation,infection and pain.Then Meta-analysis was perfomed using RevMan 5.0 software.Results A total of 5389 hernias （2861 in heavyweight group,2528 in lightweight group） from 21 clinical case-controls were included in this Meta-analysis.16 of the 21 clinical case-controls were prospective randomized controlled trials （RCT）.Less postoperative foreign body sensation and less chronic pain （≥12 months） were observed in Lightweight mesh group （p0.05）,and the Odds ratio （OR） were 1.90 （95% confidence interval was 1.48,2.43） and 1.39（95% confidence interval was 1.10,1.75）.There were no significant differences in postoperative hernia recurrence,seromaor hematoma,infection and earlier postoperative pain （p0.05）.Conclusions Use of lightweight mesh was associated with less postoperative foreign body sensation and less chronic pain,and no difference in postoperative recurrence,seroma or hematoma,infection,and there was no significant difference in the incidence of early postoperative pain.