Desarda与Lichtenstein术对腹股沟疝疗效的Meta分析

doi:10.3877/cma.j.issn.1674-392X.2023.03.005

目的

比较Desarda术式与Lichtenstein术式在腹股沟疝修补术中的疗效和安全性。

方法

检索PubMed、EMBASE、Cochrane Library、万方、中国知网、维普中文科技期刊数据库等电子数据库，截取时间为2000年1月至2020年9月的文献，选择关于比较Desarda术式与Lichtenstein术式治疗腹股沟疝的随机对照试验，并由2位研究员分别对其进行质量评估及提取相关数据。主要观察指标为复发率和术后总体并发症。次要观察指标为：手术部位感染（SSI）、慢性腹股沟区疼痛或麻木、血清肿或血肿、手术时间、术后早期疼痛评分、恢复至正常日常活动或工作的总时间、睾丸萎缩。对最终纳入文献的数据整理后进行Meta分析。

结果

共纳入10项随机对照研究，包括3211例患者，其中Desarda组1573例，Lichtenstein组1638例。Desarda组和Lichtenstein组术后总体并发症、SSI、慢性腹股沟区疼痛或麻木、血清肿或血肿、手术时间比较，差异均有统计学意义。而复发率、术后早期疼痛评分、恢复至正常日常活动或工作的总时间、睾丸萎缩比较，差异无统计学意义（P>0.05）。

结论

Desarda术式在减少术后总体并发症方面优于Lichtenstein术式，尤其是在SSI、慢性腹股沟区疼痛或麻木、血肿或血清肿形成方面更具优势。

关键词: 疝，腹股沟, 疝修补术, Meta分析, Lichtenstein, Desarda

Objective

To compare the efficacy and safety of Desarda and Lichtenstein in inguinal hernia repair.

Methods

Two researchers searched the electronic medical database (PubMed, EMBASE, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and VIP Chinese Science and Technology Journal Database) for randomized controlled trials comparing Desarda surgery with Lichtenstein surgery for the treatment of inguinal hernias from January 2000 to September 2020. The quality of the studies was assessed, and the pertinent data were collected. Recurrence rate and total postoperative complications were the primary outcome indicators. Surgical site infection (SSI), chronic groin discomfort or numbness, seroma or hematoma, operation time, early postoperative pain score, total time to return to regular daily activities or a job, and testicular atrophy were secondary outcome measures. Data from the included literature was gathered and subjected to a meta-analysis for analysis.

Results

A total of 10 RCTs involving 3211 patients were included, including 1573 in the Desarda group and 1638 in the Lichtenstein group. There were significant differences between the Desarda group and the Lichtenstein group in postoperative complications, surgical site infection (SSI), chronic groin pain or numbness, seroma or hematoma formation, and operation time. There was no significant difference in recurrence rate, early postoperative pain, the total time to return to normal daily activities or work, and testicular atrophy.

Conclusion

Desarda is superior to Lichtenstein in reducing postoperative complications, especially SSI, chronic inguinal pain or numbness, hematoma, or seroma.

Key words: Hernia, inguinal, Herniorrhaphy, Meta-analysis, Lichtenstein, Desarda

图1 文献筛选流程图

图2 纳入评价的偏倚风险评估总结

表1 纳入研究的人群基线资料

第一作者	发表年份	国家	研究持续时间	随访时间(月)	人口分布
第一作者	发表年份	国家	研究持续时间	随访时间(月)	DT	LT
Ahmed^[8]	2018	埃及	2012-05至2016-11	36	65/130	65/130
Arafa^[9]	2020	埃及	2016-03至2019-03	24	40/80	40/80
Muhammad^[10]	2017	巴基斯坦	2017-01至2017-06	6	30/60	30/60
Poongavanam^[11]	2018	印度	2017至2018	12	51/102	51/102
Rahman^[12]	2019	孟加拉国	2013-10至2016-10	24	54/100	46/100
Rodriguez^[13]	2018	古巴	2002-01至2016-12	120	1075/2225	1150/2225
Sowmya^[14]	2015	印度	2006-06至2008-05	12	20/40	20/40
Szopinski^[15]	2012	波兰	2005-01至2006-06	36	105/208	103/208
Vupputuri^[16]	2019	印度	2013-08至2013-10	36	62/123	61/123
Youssef^[17]	2015	埃及	2010-12至2012-12	24	71/143	72/143

表1 纳入研究的人群基线资料

第一作者	发表年份	国家	研究持续时间	随访时间(月)	人口分布
第一作者	发表年份	国家	研究持续时间	随访时间(月)	DT	LT
Ahmed^[8]	2018	埃及	2012-05至2016-11	36	65/130	65/130
Arafa^[9]	2020	埃及	2016-03至2019-03	24	40/80	40/80
Muhammad^[10]	2017	巴基斯坦	2017-01至2017-06	6	30/60	30/60
Poongavanam^[11]	2018	印度	2017至2018	12	51/102	51/102
Rahman^[12]	2019	孟加拉国	2013-10至2016-10	24	54/100	46/100
Rodriguez^[13]	2018	古巴	2002-01至2016-12	120	1075/2225	1150/2225
Sowmya^[14]	2015	印度	2006-06至2008-05	12	20/40	20/40
Szopinski^[15]	2012	波兰	2005-01至2006-06	36	105/208	103/208
Vupputuri^[16]	2019	印度	2013-08至2013-10	36	62/123	61/123
Youssef^[17]	2015	埃及	2010-12至2012-12	24	71/143	72/143

表2 纳入研究的基本特征

第一作者	组别	病例数	年龄(岁,±s)	性别(例,男:女)	疝的位置（例）			结局指标
第一作者	组别	病例数	年龄(岁,±s)	性别(例,男:女)	右侧	左侧	双侧	结局指标
Ahmed^[8]	DT	65	38±11.55	61:4	39	21	5	A B
Ahmed^[8]	LT	65	40±11.69	65:0	41	18	6	A B
Arafa^[9]	DT	40	32.8±7.9	不详	8	32	不详	A B C D E F G H I
Arafa^[9]	LT	40	34.65±8.12	不详	13	27	不详	A B C D E F G H I
Muhammad^[10]	DT	30	50.24±10.89	30:0	不详	不详	不详	A B C E F G
Muhammad^[10]	LT	30	52.13±12.55	30:0	不详	不详	不详	A B C E F G
Poongavanam^[11]	DT	51	不详	不详	33	18	0	A B E F
Poongavanam^[11]	LT	51	不详	不详	31	20	0	A B E F
Rahman^[12]	DT	54	50.33±5.12	54:0	35	19	0	A B C D E F G H
Rahman^[12]	LT	46	56.17±6.34	46:0	30	16	0	A B C D E F G H
Rodriguez^[13]	DT	1075	58.2	1002:73	530	510	35	A B D E I
Rodriguez^[13]	LT	1150	57.4	1077:73	552	522	76	A B D E I
Sowmya^[14]	DT	20	46.6±16.2	20:0	15	5	0	A B D E H
Sowmya^[14]	LT	20	44.1±12.9	20:0	14	6	0	A B D E H
Szopinski^[15]	DT	105	50.2±17.5	105:0	59	42	4	A B C E I
Szopinski^[15]	LT	103	54.1±15.3	103:0	54	41	8	A B C E I
Vupputuri^[16]	DT	62	49.97±13.25	62:0	不详	不详	不详	A B C D E F G
Vupputuri^[16]	LT	61	53.13±11.31	61:0	不详	不详	不详	A B C D E F G
Youssef^[17]	DT	71	45.97±10.69	69:2	49	22	0	A B C D E F G H
Youssef^[17]	LT	72	43.89±10.27	69:3	56	16	0	A B C D E F G H

表2 纳入研究的基本特征

第一作者	组别	病例数	年龄(岁,±s)	性别(例,男:女)	疝的位置（例）			结局指标
第一作者	组别	病例数	年龄(岁,±s)	性别(例,男:女)	右侧	左侧	双侧	结局指标
Ahmed^[8]	DT	65	38±11.55	61:4	39	21	5	A B
Ahmed^[8]	LT	65	40±11.69	65:0	41	18	6	A B
Arafa^[9]	DT	40	32.8±7.9	不详	8	32	不详	A B C D E F G H I
Arafa^[9]	LT	40	34.65±8.12	不详	13	27	不详	A B C D E F G H I
Muhammad^[10]	DT	30	50.24±10.89	30:0	不详	不详	不详	A B C E F G
Muhammad^[10]	LT	30	52.13±12.55	30:0	不详	不详	不详	A B C E F G
Poongavanam^[11]	DT	51	不详	不详	33	18	0	A B E F
Poongavanam^[11]	LT	51	不详	不详	31	20	0	A B E F
Rahman^[12]	DT	54	50.33±5.12	54:0	35	19	0	A B C D E F G H
Rahman^[12]	LT	46	56.17±6.34	46:0	30	16	0	A B C D E F G H
Rodriguez^[13]	DT	1075	58.2	1002:73	530	510	35	A B D E I
Rodriguez^[13]	LT	1150	57.4	1077:73	552	522	76	A B D E I
Sowmya^[14]	DT	20	46.6±16.2	20:0	15	5	0	A B D E H
Sowmya^[14]	LT	20	44.1±12.9	20:0	14	6	0	A B D E H
Szopinski^[15]	DT	105	50.2±17.5	105:0	59	42	4	A B C E I
Szopinski^[15]	LT	103	54.1±15.3	103:0	54	41	8	A B C E I
Vupputuri^[16]	DT	62	49.97±13.25	62:0	不详	不详	不详	A B C D E F G
Vupputuri^[16]	LT	61	53.13±11.31	61:0	不详	不详	不详	A B C D E F G
Youssef^[17]	DT	71	45.97±10.69	69:2	49	22	0	A B C D E F G H
Youssef^[17]	LT	72	43.89±10.27	69:3	56	16	0	A B C D E F G H

图3 Desarda组和Lichtenstein组复发情况的比较

图4 Desarda组和Lichtenstein组术后总体并发症比较

图5 Desarda组和Lichtenstein组术后手术部位感染发生率比较

图6 Desarda组和Lichtenstein组术后慢性腹股沟区疼痛或麻木比较

图7 Desarda组和Lichtenstein组术后血清肿或血肿形成的比较

图8 Desarda组和Lichtenstein组手术时间比较

图9 Desarda组和Lichtenstein组术后早期疼痛评分比较

图10 Desarda组和Lichtenstein组术后恢复至正常日常活动或工作的总时间比较

图11 Desarda组和Lichtenstein组术后发生睾丸萎缩情况比较

图12 文献发表偏倚漏斗图

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Comparison of Desarda and Lichtenstein in inguinal hernia repair: a meta-analysis

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Comparison of Desarda and Lichtenstein in inguinal hernia repair: a meta-analysis