腹腔镜经腹腹膜前腹股沟疝修补术与完全腹膜外疝修补术疗效对比的Meta分析

Laparoscopic transabdominal preperitoneal versus totally extraperitoneal inguinal hernia repair: a Meta-analysis of efficacy comparison

目的：对比腹腔镜经腹腹膜前（transabdominal preperitoneal，TAPP）与完全腹膜外（totally extraperitoneal，TEP）腹股沟疝修补术治疗成人腹股沟疝患者的临床疗效。方法：计算机检索2000～2012年PubMed、EMbase、scifinder scholar、ovidfulltext数据库。检索语种为英语。纳入的随机或半随机对照试验为TAPP与TEP在成人患者中的临床效果比较，由两名工作人员分别提取数据，并对纳入的研究进行质量评估。最后采用RevMan5．0软件进行统计分析并得出结论。结果：最终纳入7个试验，共包含1999例患者。两种术式在手术时间[OR=0．90，95％CI（-5．31，7．11），P=0．78]、术后住院时间[OR=-0．08，95％CI（-1．22，1．07），P=0．90]、术后疼痛[OR=0．21，95％CI（-0．31，0．74），P=0．42]、远期复发率[OR=1．23，95％CI（0．53，2．87），P=0．63]、术后并发症发生率[OR=1．82，95％CI（0．83，4．01），P=0．14]方面差异均无统计学意义；但术后恢复工作时间[OR=3．83，95％CI（3．05，4．61），P〈0．00001]差异有统计学意义。结论：TAPP与TEP均是治疗腹股沟疝安全、有效的术式，在术后恢复正常工作时间方面TEP优于TAPP，其他方面的区别尚需进一步研究。

Objective：To compare the clinical effects of laparoscopic transabdominal preperitoneal herniorrhaphy （TAPP） and totally extraperitoneal herniorrhaphy （TEP） in adults with inguinal hernia. Methods：The searching was carried out in PubMed, EM- base, scifinder scholar,ovid fulhext database （2000-2012） in English. Randomized or quasi-randomized controlled trials of TAPP and TEP for treating inguinal hernia in adults were considered for inclusion. Two reviewers independently extracted the data related to clini- cal outcomes and evaluated the quality of the included studies. RevMan 5.0 software was used to carry out statistical analyses. Results： Seven reports involving 1 999 participants were included in the study. Compared with TAPP ,TEP had no significant differences in oper- ation time [ OR = 0.90,95 % CI （ -5.31,7.11 ）, P = 0.78 ], length of postoperative hospital stay [ OR = -0.08,95 % CI （ -1.22,1.07 ）, P = 0.90 ], postoperative pain [ OR = 0.21,95 % CI （ -0.31,0.74）, P = 0.42 ], long term recurrence [ OR = 1.23,95 % CI （0.53,2.87）, P =0.63 ] and postoperative complication [ OR = 1.82,95% CI（0. 83 ,4. 01 ） ,P =0.14], but there was a statistical difference in time of return to work [ OR = 3.83,95 % CI （3.05,4.61）, P 〈 0. 00001 ]. Conclusions ： Both TAPP and TEP are safe and effective in the treatment of inguinal hernia. Current evidence suggests that TEP is superior to TAPP in lessening time to resume normal work. The differences in other aspects still need further research.