完全腹膜外腔镜手术与开放手术治疗腹股沟疝临床疗效的Meta分析

Meta-analysis of clinical efficacy on totally extraperitoneal inguinal hernia repair and open surgery in the treatment of inguinal hernia

目的运用Meta分析方法系统评价完全腹膜外腹腔镜疝修补术(TEP)与开放疝修补术的安全性及有效性.方法计算机检索CMB、EMbase、Cochrane图书馆及中国知网、万方数据知识服务平台、中国生物医学文献平台等数据库,纳入全腹膜外腔镜疝修补及开放疝修补治疗腹股沟疝随机对照试验,检索时限均为建库至2018年6月,并手动检索纳入相关文献,独立进行文献筛选,评价方法质量,并采用RevMan5.3软件进行统计分析试验结果.结果本研究共纳入11篇文献,共926例患者,其中TEP组481例,对照组445例.Meta分析结果显示,TEP组在切口长度[MD=-2.17,95%CI(-3.02,-1.32),P<0.05]、术中出血量[MD=-3.68,95%CI(-6.32,-1.04),P<0.05]、术后平均住院时间[MD=-2.03,95%CI(-2.74,-1.31),P<0.05]、术后疼痛评分[MD=-1.79,95%CI(-2.72,-0.86),P<0.05]均优于开放组,差异均有统计学意义;术后并发症总发生率[OR=0.96,95%CI(0.60,1.55),P>0.05]及复发率[OR=1.28,95%CI(0.53,3.11),P>0.05]均无显著性差异.结论完全腹膜外腹腔镜疝修补术治疗较为微创,切口较小、术中出血较少及术后疼痛较轻微,可以减少患者平均住院时间,但在减少术后并发症及复发率方面尚未见优势,仍需开展深入研究进一步验证.

Objective To systematically evaluate the safety and efficacy of total extraperitoneal laparoscopic hernioplasty(TEP)and open hernioplasty by using Meta analysis method.Methods The databases of CMB,EMbase,Cochrane Library,China HowNet,Wanfang Data Knowledge Service Platform and China Biomedical Literature Platform were retrieved by computer and included in the randomized controlled trials of total extraperitoneal laparoscopic hernioplasty and open hernioplasty for inguinal hernia.The retrieval time was from the establishment of the database to Jun 2018,and the relevant literature was manually retrieved and independently screened.RevMan 5.3 software was used to analyze the test results.Results A total of 11 articles were included in this study,including 926 patients,481 in TEP group and 445 in control group.Meta analysis showed that TEP group had significantly better incision length[MD=-2.17,95%CI(-3.02,-1.32),P<0.05],intraoperative bleeding[MD=-3.68,95%C(I-6.32,-1.04),P<0.05],mean hospital stay[MD=-2.03,95%C(I-2.74,-1.31),P<0.05],post-operative pain score[MD=-1.79,95%C(I-2.72,-0.86),P<0.05],the complication rate[OR=0.96,95%C(I 0.60,1.55),P>0.05]and recurrence rate[OR=1.28,95%CI(0.53,3.11),P>0.05]had no significant difference.Conclusion Complete extraperitoneal laparoscopic hernioplasty is a minimally invasive procedure with less incision,less bleeding and less pain.It can reduce the average hospital stay.However,it has no advantage in reducing complications and recurrence rate after operation.Therefore,further research is needed to verify it.