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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 401 -409. doi: 10.3877/cma.j.issn.1674-392X.2021.04.022

循证医学

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
李芳1,†(), 王峻峰1   
  1. 1. 215007　解放军联勤保障部队第904医院苏州医疗区普外科
  • 收稿日期:2020-01-22 出版日期:2021-08-18
  • 通信作者: 李芳

Meta-analysis of clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia

Fang Li1,†(), Junfeng Wang1   

  1. 1. Department of General Surgery, Suzhou Medical District, 904 Hospital of PLA Joint Logistics Support Force, Suzhou 215007, China
  • Received:2020-01-22 Published:2021-08-18
  • Corresponding author: Fang Li
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引用本文：

李芳, 王峻峰. 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[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(04): 401-409.

Fang Li, Junfeng Wang. Meta-analysis of clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(04): 401-409.

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。

关键词: 腹股沟复发疝, 经腹腹膜前疝修补术, 腹腔镜, Meta分析
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.

Key words: Recurrent inguinal hernia, Transabdominal preperitoneal hernioplasty, Laparoscopy, Meta-analysis
图1 文献筛选流程图
表1 纳入各项研究的基本特征
文献来源 总例数 试验组 对照组 随访时间
例数 年龄(岁, ±s) 手术方式 例数 年龄(岁, ±s) 手术方式
赵坤2018[8] 54 男(27) 60.10±6.20 TAPP 男(27) 60.60±6.10 腹腔镜全腹膜外疝修补术 未提及
李剑锋2014[7] 65 男(31),女(3) 55.80±8.90 TAPP 男(29),女(2) 51.60±9.30 Lichtenstein 0.50~7.75个月
汪丽伟2018[5] 80 男(40) 52.75± 6.29 TAPP 男(40) 52.82±6.23 Lichtenstein 未提及
张盛烺2019[9] 男(31),女(9) 20(性别未提及) 43.10±2.20 TAPP 20(性别未提及) 43.10±2.20 开放性无张力疝修补手术 未提及
Dedemadi 2006[10] 82 24 65.0 TAPP 26 65.0 TEP 3.0年
32 Lichtenstein
Eklund 2007[11] 147 男(73) 52.0±10.40 TAPP 男(74) 55.0±11.30 Lichtenstein 4.90~7.20个月
Yang 2018[4] 122 59 52.70±16.60 TAPP 63 58.20±13.10 Lichtenstein 3.85±0.57个月
Saber 2015[12] 180 60 42~65 TAPP 60 42~65 开放性腹膜前后入路手术 2007年1个月-2011年4个月
60 42~65 Lichtenstein
Gass 2016[13] 1309 287 57.8±14.5 TAPP 1022 55.6±14.9 腹腔镜全腹膜外疝修补术 1995-2006年
Lydeking 2020[14] 265 136 ≥18且<81 TAPP 129 ≥18且<81 Lichtenstein 12年
表2 纳入的各项研究的偏倚风险相关评估
纳入研究 随机方法 是否盲法 分配隐藏 结果数据的完整性 选择性报告实验研究结果 其他偏倚控制
赵坤2018[8] 随机数字表法 否 不清楚 不清楚 不清楚 不清楚
李剑锋2014[7] 不随机(按患者意愿) 否 不清楚 不清楚 不清楚 不清楚
汪丽伟2018[5] 随机数据表法 否 不清楚 不清楚 不清楚 不清楚
张盛烺2019[9] 随机数字表法 否 不清楚 不清楚 不清楚 不清楚
Dedemadi 2006[10] 随机分配 不清楚 是 是 否 不清楚
Eklund 2007 随机分配 不清楚 是 是 否 不清楚
Eklund 2007[11] 随机分配 不清楚 是 是 否 不清楚
Yang 2018[4] 随机分配 不清楚 不清楚 是 否 不清楚
Saber 2015[12] 仅提及前瞻性 不清楚 不清楚 是 否 不清楚
Lydeking 2020[14] 随机分配 是 不清楚 是 否 不清楚
图2 试验组与对照组手术时间的森林图
图3 试验组与对照组手术时间的森林图（亚组分析）
图4 试验组与对照组肛门排气时间的森林图
图5 试验组与对照组住院时间的森林图
图6 试验组与对照组住院时间的森林图（亚组分析）
图7 试验组与对照组术后并发症的森林图
图8 试验组与对照组术后并发症的森林图（亚组分析）
图9 试验组与对照组术后复发率的森林图
图10 试验组与对照组术后复发率的森林图（亚组分析）
图11 漏斗图
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