摘要
目的研究腹腔镜经腹腹膜前疝修补术治疗腹股沟复发疝的临床疗效及安全性。方法以计算机检索PubMed、中国生物医学文献服务系统、中国知网、万方数据库等中英文数据库,收集自建库到2019年6月与腹腔镜经腹腹膜前疝修补术治疗腹股沟复发疝的临床疗效及安全性的相关研究,由2名研究人员严格按照纳入/排除标准独立完成文献筛选、相关资料提取以及质量评价等,数据采用RevMan 5.3统计学软件进行Meta分析。结果纳入10篇研究,包括2583例患者。Meta分析结果显示:(1)试验组的手术时间与对照组相比,差异不明显(P>0.05);亚组分析中,无张力修补术组(包括Lichtenstein)及腹腔镜完全腹膜外疝修补术组中试验组的手术时间与对照组相比,差异不明显(P>0.05),而开放性腹膜前后入路手术组中试验组的手术时间与对照组相比,差异明显(P<0.05)。(2)试验组的肛门排气时间与对照组相比,差异不明显(P>0.05)。(3)试验组的住院时间与对照组相比,差异明显(P>0.05);亚组分析结果:无张力修补术组中试验组的住院时间与对照组相比,差异不明显(P>0.05),而TEP组及开放性腹膜前后入路手术组中试验组的住院时间与对照组相比,差异明显(P<0.05)。(4)试验组的术后并发症与对照组相比,差异明显(P<0.05);亚组分析结果:无张力修补术组及开放性腹膜前后入路手术组中试验组的术后并发症与对照组相比,差异明显(P<0.05),而TEP组中试验组的术后并发症与对照组相比,差异不明显(P>0.05)。(5)试验组的术后复发率与对照组相比,差异不明显(P<0.05);亚组分析结果:无张力修补术组中试验组的术后复发率与对照组相比,差异明显(P<0.05),而TEP组及开放性腹膜前后入路手术组中试验组的住院时间与对照组相比,差异不明显(P>0.05)。结论腹腔镜经腹腹膜前疝修补术治疗腹股沟复发疝有较大的优势——术后并发症少、复发率不高,值得临床推广应用。
Objective To study the clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia.Methods PubMed,China Biomedical Literature Service System,China HowNet and Wanfang database were retrieved by computer.The clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia from database building to June 2019 were collected and strictly reviewed by two researchers according to the inclusion/exclusion criteria.The two researchers independently completed literature screening,related data extraction and quality evaluation.Data were analyzed by RevMan 5.3 statistical software.Results 10 studies involving 2583 patients were included.The results of meta-analysis showed that:(1)There was no significant difference in operation time between the experimental group and the control group(P>0.05);Subgroup analysis results:in tension-free repair group(including Lichtenstein)and TEP group,the operation time of the experimental group was not significantly different from that of the control group(P>0.05),while in open posterior preperitoneal approach group,the operation time of the experimental group was significantly different from that of the control group(P<0.05).(2)There was no significant difference in anal exhaust time between the experimental group and the control group(P>0.05).(3)The length of hospital stay of the experimental group was significantly different from that of the control group(P>0.05);Subgroup analysis results:the length of hospital stay of the experimental group was not significantly different from that of the control group in the tension-free repair group(P>0.05),while the length of hospital stay of the experimental group was significantly different from that of the control group in the TEP group and the open posterior preperitoneal approach operation group(P<0.05).(4)There was significant difference in postoperative complications between the experimental group and the control group(P<0.05);Subgroup analysis results:in tension-free repair group and open posterior preperitoneal approach operation group,the postoperative complications of the experimental group were significantly different from those of the control group(P<0.05),while in TEP group,the postoperative complications of the experimental group were not significantly different from those of the control group(P>0.05).(5)There was no significant difference in the recurrence rate between the experimental group and the control group(P<0.05);Subgroup analysis results:in the tension-free repair group,the postoperative recurrence rate of the experimental group was significantly higher than that of the control group(P<0.05),while in the TEP group and the open posterior preperitoneal approach operation group,the hospital stay of the experimental group was not significantly different from that of the control group(P>0.05).Conclusion Laparoscopic transabdominal preperitoneal herniorrhaphy has great advantages in the treatment of recurrent inguinal hernia with less postoperative complications and low recurrence rate,and it is worthy of clinical application.
作者
李芳
王峻峰
Li Fang;Wang Junfeng(Department of General Surgery,Suzhou Medical District,904 Hospital of PLA Joint Logistics Support Force,Suzhou 215007,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2021年第4期421-429,共9页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
腹股沟复发疝
经腹腹膜前疝修补术
腹腔镜
META分析
Recurrent inguinal hernia
Transabdominal preperitoneal hernioplasty
Laparoscopy
Meta-analysis
