切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 75 -82. doi: 10.3877/cma.j.issn.1674-392X.2020.01.019

所属专题: 文献

循证医学

Lichtenstein疝修补术和网塞修补术治疗原发性腹股沟疝的Meta分析
于志远1, 杨诗语1, 张旭1, 孙岩1,()   
  1. 1. 150086 哈尔滨医科大学附属第二医院普外七科
  • 收稿日期:2019-11-25 出版日期:2020-02-18
  • 通信作者: 孙岩
  • 基金资助:
    黑龙江省自然基金资助项目(H2016028)

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

Zhiyuan Yu1, Shiyu Yang1, Xu Zhang1, Yan Sun1,()   

  1. 1. Department of General Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, China
  • Received:2019-11-25 Published:2020-02-18
  • Corresponding author: Yan Sun
引用本文:

于志远, 杨诗语, 张旭, 孙岩. Lichtenstein疝修补术和网塞修补术治疗原发性腹股沟疝的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(01): 75-82.

Zhiyuan Yu, Shiyu Yang, Xu Zhang, Yan Sun. Meta-analysis of Lichtenstein repair and mesh-plug repair for primary inguinal hernia[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(01): 75-82.

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<0.000 01],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<0.000 01], 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.

图2 纳入研究的偏倚风险评估总结
图1 文献筛选流程及结果
表1 纳入研究的基本资料
图3 Mesh-plug组和Lichtenstein组手术时间比较
图4 Mesh-plug组和Lichtenstein组术后早期疼痛评分比较
图5 Mesh-plug组和Lichtenstein组术后腹股沟区不适感比较
图6 Mesh-plug组和Lichtenstein组术后伤口感染比较
图7 Mesh-plug组和Lichtenstein组术后血肿和血清肿比较
图8 Mesh-plug组和Lichtenstein组术后慢性疼痛比较
图9 Mesh-plug组和Lichtenstein组术后复发比较
图10 Mesh-plug组和Lichtenstein组补片费用比较
图11 术后疝复发的文献漏斗图
[1]
Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J]. Hernia, 2009, 13(4): 343-403.
[2]
陈双,周太成. 腹壁与疝外科2017年热点回顾与未来展望[J]. 中华胃肠外科杂志, 2018, 21(1): 19-22.
[3]
Campanelli G, Bruni PG, Morlacchi A, et al. Primary inguinal hernia: The open repair today pros and cons[J]. Asian J Endosc Surg, 2017, 10(3): 236-243.
[4]
Legutko J, Pach R, Solecki R, et al. The history of treatment of groin hernia[J]. Folia Med Cracov, 2008, 49(1-2): 57-74.
[5]
唐健雄,黄磊,李绍杰, 等. 我国疝和腹壁外科前景展望[J]. 中华外科杂志, 2017, 55(1): 15-19.
[6]
Li J, Ji Z, Li Y. Comparison of mesh-plug and Lichtenstein for inguinal hernia repair: a meta-analysis of randomized controlled trials[J]. Hernia, 2012, 16: 541-548.
[7]
周建平,刘祺. 成人腹股沟疝无张力修补术随机对照试验的Meta分析[J]. 中国循证医学杂志, 2005, 5(4): 303-310.
[8]
杨慧琪,刘敏,申英末. 2018年国际腹股沟疝指南解读:成人腹股沟疝管理(一)[J/CD]. 中华疝和腹壁外科杂志(电子版), 2018, 12(5), 321-325.
[9]
中华医学会外科学分会疝与腹壁外科学,中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J/CD]. 中华疝和腹壁外科杂志(电子版), 2018, 12(4): 244-246.
[10]
Mulrow CD, Oxman A. How to conduct a Conchrane systematic review. The Cochrane Library(Issue 2). The Cochrane Collaboration Handbook(version 3. 0. 2). San Antonio Cochrane Collaboration, 1997.
[11]
Dalenbäck J., Andersson, Anesten, et al. Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. Hernia, 2009, 13: 121-129.
[12]
Bringman S, Ramel S, Heikkinen T, et al. Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial[J]. Ann Surg, 2003, 237(1): 142-147.
[13]
Serdar Karaca, Omer Faik Ersoy, Namik Ozkan, et al. Comparison of Inguinal Hernia Repairs Performed with Lichtenstein, Rutkow- Robbins, and Gilbert Double Layer Graft Methods[J]. Indian J Surg, 2015, 77(1):28-33.
[14]
Sebahattin Destek, Vahit Onur Gul. Comparison of Lichtenstein Repair and Mesh Plug Repair Methods in The Treatment of Indirect Inguinal Hernia[J]. Cureus, 2018, 10(7).
[15]
Kingsnorth AN, Porter CS, Bennett DH, et al. Lichtenstein patch or Perfix plug and patch in inguinal hernia: A prospective double-blind randomized controlled trial of short-term outcome[J]. Surgery, 2000, 127(3): 276-283.
[16]
Droeser RA, Dell-Kuster S, Kurmann A, et al. Long-term follow-up of a randomized controlled trial of Lichtenstein's operation versus mesh plug repair for inguinal hernia[J]. Ann Surg, 2014, 259: 966-972.
[17]
Simon W. Nienhuijs, Camiel Rosman. Long-term outcome after randomizing prolene hernia system, mesh plug repair and lichtenstein for inguinal hernia repair[J]. Hernia 2015, 19(1): 77-81.
[18]
Mayagoitia JC, Prieto-Dı´az Cha´vez E, Sua´rez D, et al. Predictive factors comparison of complications and recurrences in three tension-free herniorraphy techniques[J]. Hernia, 2006, 10: 147-151.
[19]
Simon Nienhuijs, Barbara Kortmann, Michiel Boerma, et al. Preferred Mesh-Based Inguinal Hernia Repair in a Teaching Setting[J]. Arch Surg, 2004, 139: 1097-1100.
[20]
Frey DM, Wildisen A, Hamel CT, et al. Randomized clinical trial of Lichtenstein’s operation versus mesh plug for inguinal hernia repair[J]. Br J Surg, 2007, 94(5): 36-41.
[21]
Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair[J]. Int Surg, 1986, 71(1): 1-4.
[22]
Rutkow I M, Robbins A W. Mesh plug hernia repair: A follow-up report[J]. Surgery, 1995, 117(5): 597-598.
[23]
Liu Z, Xiong Z, Wu J, et al. Clinical curative effect of Mesalt combined with Mepilex dressing in postoperative infection of inguinal hernia[J]. Med Sci Monit, 2015, 21: 1038-1042.
[24]
杨林华,陈涛,王坚. 腹股沟嵌顿疝术后手术部位感染因素分析[J]. 中国实用外科杂志, 2012, 32(12): 1043-1045.
[25]
Cobb WS, Carbonell AM, Kalbaugh CL, et al. Infection risk of open placement of intraperitoneal composite mesh[J]. Am Surg, 2009, 75(9): 762-767.
[26]
Li W, Sun D, Sun Y, et el. The effect of transabdominal preperitoneal(TAPP) inguinal hernioplasty on chronic pain and quality of life of patients: mesh fixation versus non-fixation[J]. Surg Endosc, 2017, 31(10): 4238-4243.
[27]
Lange JF, Kaufmann R, Wijsmuller AR, et al. An international consensus algorithm for management of chronic postoperative inguinal pain[J]. Hernia, 2015, 19(1): 33-43.
[28]
Huang CS, Huang CC, Lien HH. Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair[J]. Hernia, 2005, 9(2): 167-171.
[29]
程若川,刁畅,张建明, 等. 传统、改良疝环充填式和普理灵疝装置在无张力腹股沟疝修补中的对比研究[J/CD]. 中华疝和腹壁外科杂志(电子版)2007, 11(1): 80-83.
[30]
Sevilla C, Dajani D, Aron M. Migrated Mesh Plug Masquerading as a Bladder Tumor[J]. J Endourol Case Rep, 2017, 3(1): 1-3.
[31]
D'Amore L, Gossetti F, Manto O, et al. Mesh plug repair: can we reduce the risk of plug erosion into the sigmoid colon?[J]. Hernia, 2012, 16(4): 495-496.
[32]
Michael Ohene-Yeboah, Jessica H. Beard, Benjamin Frimpong- Twumasi, et al. Prevalence of Inguinal Hernia in Adult Men in the Ashanti Region of Ghana[J]. World J Surg, 2016, 40(4): 806-812.
[1] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4] 奚玲, 仝瀚文, 缪骥, 毛永欢, 沈晓菲, 杜峻峰, 刘晔. 基于肌少症构建的造口旁疝危险因素预测模型[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 48-51.
[5] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[6] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[7] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[8] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[9] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[10] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[11] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[12] 刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[13] 嵇振岭, 陈杰, 唐健雄. 重视复杂腹壁疝手术并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 601-606.
[14] 江志鹏, 钟克力, 陈双. 复杂腹壁疝手术后腹腔高压与腹腔间室综合征的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 612-615.
[15] 王学虎, 赵渝. 复杂腹壁疝手术中血管损伤并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 616-619.
阅读次数
全文


摘要