应用轻型与重型网片开放式修补腹股沟疝的Meta分析

The use of lightweight versus heavyweight mesh in open methods of inguinal hernia repair: A meta-analysis

背景:目前对于轻型网片及重型网片修补腹股沟疝谁更具优势存在争议。目的:采用Meta分析的方法比较重型与轻型补片开放式修补腹股沟疝的疗效。方法:计算机检索PubMed、Cochrane library、EMBASE、Medline、Ovid、万方、知网、维普、中国生物医学文献数据库、康健等数据库,并追查已纳入研究的参考文献,检索时间从建库至2013年2月。收集比较重型与轻型补片应用于开放式腹股沟疝修补的前瞻性随机对照试验,按预设标准进行筛选,对纳入研究进行质量评价,提取数据后用RevMan5.1软件进行Meta分析。结果与结论:纳入18个随机对照试验,共4 450例腹股沟疝。Meta分析结果显示,与重型网片相比,轻型网片修补腹股沟疝后短期内疼痛及异物感较少[OR=0.57,95%可信区间(0.43,0.74),P<0.05]、[OR=0.49,95%可信区间(0.35,0.69),P<0.05];两组修补手术后复发、血清肿、血肿、切口感染、睾丸萎缩、尿潴留、中长期疼痛方面差异无显著性意义(P>0.05)。现有证据表明,轻型网片修补腹股沟疝是安全可行的,能达到与重型网片相似的临床疗效,但因纳入文献的质量不高及样本量有限,上述结论需要大样本及高质量的临床随机对照试验来提供更好的循证证据。

BACKGROUND： It remains controversial in term of efficacy for the lightweight mesh and heavyweight mesh in inguinal hernia repair.OBJECTIVE： To compare the clinical therapeutic effects of lightweight mesh and heavyweight mesh in open methods of inguinal hernia repair with Meta-analysis.METHODS： Comprehensive electronic search strategies were developed using the following electronic databases：PubMed, Cochrane Library, EMBASE, Medline, Ovid, CNKI, VIP, Wanfang and FMJS. The Literature published before February 2013 was searched. The randomized controlled trials about comparing lightweight mesh and heavyweight mesh in open methods of inguinal hernia repair were included. A data-extraction sheet was developed based on the preset standards. The data from eligible studies were pooled using RevMan5.1 software through Meta-analysis.RESULTS AND CONCLUSION： Eighteen trials with a total of 4 450 hernias met the inclusion criteria. The meta-analysis showed that there was a statistical difference between lightweight mesh group and the heavyweight mesh group on short-term pain [odd ratio（OR）=0.57, 95% confidence interval（CI）（0.43, 0.74）,P 0.05] and a reduced risk of developing foreign body sensations [OR=0.49, 95% CI（0.35, 0.69）, P 0.05]. No significant differences were found between the two groups in recurrence rate, testicular atrophy, seroma,hematoma, wound infection, urine retention（P 0.5）. According to limited evidence, there are some findings asfollows： the lightweight mesh is of feasibility, safety and effectiveness for inguinal hernia repair. Because of the limits of sample and quality, more large-sample and high-quality trials are required to make a definite clinical evidence to use lightweight mesh for inguinal hernia repair.