Lichtenstein疝修补术和网塞修补术治疗原发性腹股沟疝的Meta分析

Meta-analysis of Lichtenstein repair and mesh-plug repair for primary inguinal hernia

目的系统评价前入路平片(Lichtenstein)无张力疝修补术与网塞充填式(Mesh-plug)无张力疝修补术在腹股沟疝治疗中的应用效果。方法制订纳入和排除标准,检索数据库中发表时间在2000年1月至2019年6月的文献,并结合所查找文献中的参考文献,选择有关Lichtenstein疝修补与Mesh-plug疝修补治疗原发性腹股沟疝的临床随机对照研究,由2位作者分别进行质量评估并提取数据资料,结局指标包括手术时间、术后复发、补片费用、血肿与血清肿、腹股沟区不适感、疼痛及感染情况,将最终纳入的文献数据整理后进行Meta分析。结果共有10篇RCT研究纳入分析,Lichtenstein组1472例,Mesh-plug组1457例。Meta分析结果显示:与Mesh-plug疝修补术相比,Lichtenstein疝修补术后血肿、血清肿发生率更低[RR=1.45,95%CI(1.02,2.06),P=0.04],手术费用更少[WMD=155.15,95%CI(112.78,197.53),P<0.00001],但手术时间稍长[WMD=-7.51,95%CI(-11.33,-3.68),P=0.0001]。而两者术后腹股沟区不适感、感染、复发、早期疼痛评分以及慢性疼痛的发生率无明显差异。结论与Mesh-plug疝修补术相比,Lichtenstein疝修补术在降低术后血清肿、血肿发生率以及手术费用方面有一定优势,但手术时间稍长,建议在临床上Lichtenstein疝修补术优先Mesh-plug疝修补术使用。

Objective To systematically evaluate the application effect of tension-free hernia repair with Lichtenstein and Mesh-plug in the treatment of primary inguinal hernia.Methods The inclusion and exclusion criteria were set up.We searched related domestic and foreign databases,and the retrieval period was from January 2000 to June 2019.Combined with the references found in the literature,we selected the clinical randomized controlled trial on the treatment of primary inguinal hernia by Lichtenstein hernia repair and Mesh-plug hernia repair.The Quality assessment and data extraction were conducted by the two authors respectively.Outcome indicators included postoperative recurrence,mesh cost,hematoma and seroma,discomfort,infection,and pain in the inguinal area.Meta-analysis was conducted after the final included literature data were sorted out.Results A total of 10 RCT studies were included in the analysis,including 1,472 cases in the Lichtenstein group and 1,457 cases in the Mesh-plug group.Meta-analysis results showed that Lichtenstein hernia repair was better than Mesh-plug hernia repair in reducing the incidence of hematoma and seroma after operation[RR=1.45,95%CI(1.02,2.06),P=0.04]and reducing the operation cost[WMD=155.15,95%CI(112.78,197.53),P<0.00001],but Lichtenstein hernia repair had a slightly longer operation time[WMD=-7.51,95%CI(-11.33,-3.68),P=0.0001].There was no significant difference in postoperative inguinal discomfort,infection,postoperative recurrence,early pain score or incidence of chronic pain.Conclusion Lichtenstein hernia repair has certain advantages in reducing the incidence of postoperative seroma and the operation cost compared with Mesh-plug hernia repair,but the operation time of Lichtenstein is longer.It is suggested that the Lichtenstein hernia repair should be preferred for Mesh-plug hernia repair in the clinical.