腹腔镜下完全腹膜外间隙补片修补术与Lichtenstein修补术治疗成人腹股沟疝安全性和疗效的Meta分析

Totally extraperitoneal laparoscopic vs lichtenstein hernioplasty for adult inguinal hernias:a meta analysis

目的:利用Meta分析方法,评价腹腔镜下完全腹膜外间隙补片修补术(TEP)与Lichtenstein修补术(LI)治疗成人腹股沟疝的安全性及疗效。方法:选取发表于1990年1月—2015年3月对比分析TEP与LI治疗成人腹股沟疝的随机对照研究,应用Meta分析方法评价近期和远期并发症等相关结局指标。结果:共有16项前瞻性随机对照研究纳入此分析,包括4368例患者,其中TEP组2081例,LI组2287例。TEP组与LI组相比,血肿发生率降低(OR:0.77,95%CI:0.61~0.97,P=0.03)、切口感染发生率降低(OR:0.38,95%CI:0.20~0.72,P<0.05)、腹股沟区敏感性受损发生率降低(OR:0.24,95%CI:0.16~0.36,P<0.05)、恢复正常工作时间减少(OR:-4.34,95%CI:-5.79^-2.88,P<0.05)、术后慢性疼痛发生率降低(OR:0.42,95%CI:0.29~0.63,P<0.05),差异均有统计学意义。而两组在总的近期并发症发生率、血清肿发生、术后复发率等方面的差异均无统计学意义(P>0.05)。结论:TEP与LI相比,术后恢复工作时间更短,远期疼痛发生率降低,两组远期复发无明显差异。

Objective： To evaluate the safety and efficacy between totally extraperitoneal la- paroscopic （TEP） and Lichtenstein hernioplasty （LI） for adult inguinal hernias using meta-analysis method. Methods： Randomizd controlled trials comparing TEP with LI for adult inguinal hernias and published from 1990 to 2015 were recruited. This meta-analysis was conducted to estimate short-term and long-term complications. Fixed random effect model or random effect model was established to analysis the data. Results- Sixteen randomizd controlled trials were included in this analysis. These studies included 4368 patients. 2081 of them were treated with TEP and 2287 were treated with LI. The analysis of short-term and long-term complications of these included studies showed that： compared to LI, in the TEP group the hematoma incidence was lower patients （OR： 0.77,95% CI： 0.61 - 0.97, P=0.03）, wound infection was lower （0R：0.38,95% CI： 0.20 - 0.72, P〈0.05）, impaired inguinal sensibility incidence was lower （OR：0.24,95% CI： 0.16 - 0.36, P〈0.05）,the time to return to work was reduced-OR：-4.34,95% CI： -5.79 - -2.88, P〈0.05）, chronic groin pain incidence was lower （0R：0.42,95% CI： 0.29 -0.63, P〈0.05）. While in two groups, there were no significant difference in the total short-term complications,hematoma and recurrence（P〉0.05）. C-- Compared to LI, the time to return to work in the TEP group was shorter, chronic groin pain incidence was lower, the recurrence incidence was no significant difference.