腹腔镜腹股沟疝修补术经腹腔腹膜前与完全腹膜外手术入路疗效的meta分析

Laparoscopic Transabdominal Preperitoneal Versus Totally Extraperitoneal Approach of Inguinal Hernia Repair:A Meta Analysis

目的评价腹腔镜经腹腔腹膜前(TAPP)和完全腹膜外(TEP)两种手术入路在原发性腹股沟疝患者中的治疗效果。方法制定严格的纳入标准和排除标准,收集腹腔镜TAPP与TEP原发性腹股沟疝修补术临床疗效比较的随机对照试验,按照Cochrane协作网推荐的方法对纳入研究进行系统分析。结果 7篇随机对照试验(552例患者)纳入分析,TAPP组302例,TEP组250例。TAPP组与TEP组相比较,2组在手术时间〔WMD=8.49,95%CI(-1.37,18.35),P=0.09〕、术后住院时间〔SMD=0.11,95%CI(-0.12,0.34),P=0.34〕、术后复发率〔OR=1.37,95%CI(0.36,5.20),P=0.64〕、并发症(切口感染、尿潴留)发生率〔切口感染:OR=4.27,95%CI(0.85,21.57),P=0.08;尿潴留:OR=0.61,95%CI(0.21,1.78),P=0.36〕方面差异均无统计学意义,但2组在术后24 h疼痛方面,TEP组术后疼痛更轻〔WMD=0.72,95%CI(0.58,0.87),P<0.000 01〕。结论目前证据显示,TEP术后24 h疼痛程度比TAPP术更轻;手术时间、术后住院时间、术后复发及并发症方面2组差异无统计学意义,但仍需更多高质量的大样本随机对照试验进一步证实。

Objective To evaluate the clinical application of the different operative approaches of the laparoscopic repair of inguinal hernia and provide a more rational and scientific choice for the surgeon.Methods The strict inclusion and exclusion criteria were set up.All the randomized controlled trials（RCT） about laparoscopic transabdominal preperitoneal（TAPP） and totally extraperitoneal（TEP） approaches of laparoscopic inguinal hernia repair were collected.Meta an-alysis was performed according to the recommendation by the Cochrane handbook.Results Seven RCTs including 552 patients were analyzed,who were divided into TAPP group（n=302） and TEP group（n=250）.Compared with TAPP group,there were no significant differences of the operation time？（WMD=8.49,95% CI（-1.37,18.35）,P=0.09）,postoperative hospitalization？（SMD=0.11,95% CI（-0.12,0.34）,P=0.34）,postoperative recurrence rate（OR=1.37,95% CI（0.36,5.20）,P=0.64）,and complications（incision infection,urinary retention）（Incision infection：OR=4.27,95% CI（0.85,21.57）,P=0.08;Urinary retention：OR=0.61,95% CI（0.21,1.78）,P=0.36）？in the TEP group.But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group？（WMD=0.72,95% CI（0.58,0.87）,P0.000 01）？.Conclusions The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group.The time of the operation,postoperative hospitalization,postoperative recurrence,and complications are no significant differences between TAPP group and TEP group.Large-scale,high-quality RCTs are still needed to confirm or refuse the available evidence.