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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) ›› 2025, Vol. 19 ›› Issue (02) : 232 -240. doi: 10.3877/cma.j.issn.1674-392X.2025.02.022

循证医学

腹腔镜与传统开放组织结构分离技术治疗成人腹壁疝疗效的Meta 分析
赵江桥1, 杨硕2,†()   
  1. 1. 061000 河北，沧州市人民医院普通外科
    2. 100044 北京大学人民医院疝和腹壁外科
  • 收稿日期:2023-11-01 出版日期:2025-04-18
  • 通信作者: 杨硕

Efficacy of laparoscopic versus traditional open component separation technique in the treatment of adult abdominal wall hernia-A meta-analysis

Jiangqiao Zhao1, Shuo Yang2,†()   

  1. 1. Department of General Surgery, Cangzhou People's Hospital, Cangzhou 061000, Hebei Province, China
    2. Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, Beijing 100044, China
  • Received:2023-11-01 Published:2025-04-18
  • Corresponding author: Shuo Yang
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引用本文：

赵江桥, 杨硕. 腹腔镜与传统开放组织结构分离技术治疗成人腹壁疝疗效的Meta 分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(02): 232-240.

Jiangqiao Zhao, Shuo Yang. Efficacy of laparoscopic versus traditional open component separation technique in the treatment of adult abdominal wall hernia-A meta-analysis[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 232-240.

目的

综合评估微创-腹腔镜同传统-开放组织结构分离技术（CST）诊治成人（年龄≥18 岁）腹壁疝的临床效果。

方法

利用网络逐一检索国外、国内数据库，包括PubMed、Medline、Embase、Cochrane Library、Web of Science、维普数据库、中国生物医学数据库、中国知网数据库、万方数据库，检索文献的时间段从数据库建库截至2023 年8 月1 日，文献语种不限。整理所有比较微创-腹腔镜同传统-开放CST 修复成人腹壁疝的临床对照试验。根据预先制定的纳入文献标准，选择2 名评价员分别单独提取文献数据后再互相交换检查，通过Cochrane 网站提供的RevMan 5.4 版软件进行数据的统计学分析。

结果

本课题总共获取了12 篇文献，共计754 例患者。Meta 分析结果表明：相比于传统-开放CST 组，微创-腹腔镜CST 组在术后复发率（OR=0.59，95% CI 0.38～0.92，P=0.02）、术后并发症发生率（OR=0.19，95% CI 0.10～0.34，P＜0.000 01）、术中出血量（MD=-45.81，95% CI -61.56～-30.06，P＜0.000 01）和术后住院时间（MD=-2.15，95% CI -3.63～-0.67，P=0.004）方面均优于传统-开放CST 组，差异有统计学意义。但在手术时间上，微创-腹腔镜CST 组多于传统-开放CST 组（MD=16.13，95% CI 2.77～29.48，P=0.02），差异有统计学意义。

结论

相较于传统-开放CST 相，微创-腹腔镜CST 在术后复发率、术后并发症的发生率、术中出血量、术后住院时间等方面具有优势，但其手术时间略长。

关键词: 疝,腹壁, 疝修补术, 组织结构分离技术, 腹腔镜, Meta分析

Objective

To evaluate the clinical efficacy of minimally invasive laparoscopy and traditional open component separation technique (CST) in the treatment of adult (≥18 years of age)abdominal wall hernia.

Methods

PubMed, Medline, Embase, Cochrane Library, Web of Science, VIP information Chinese periodical database, CBM, CNKI and Wanfang Med Online were searched from the establishment of the database to August 1, 2023, and the language of literature was not limited.All controlled clinical trials comparing minimally invasive laparoscopic with traditional open CST for abdominal wall hernia in adults were collected.The data were extracted and cross-checked by two reviewers independently according to the pre-established inclusion criteria.The statistical analysis was performed using RevMan5.4 software provided by the Cochrane website.

Results

A total of 12 articles involving 754 patients were included in this study.Meta-analysis results showed that the minimally invasive laparoscopic CST group was better than the traditional open CST group in terms of postoperative recurrence rate (OR=0.59, 95% CI 0.38-0.92, P=0.02), postoperative complication rate (OR=0.19, 95% CI 0.10-0.34, P<0.000 01), intraoperative blood loss (MD=-45.81, 95% CI -61.56--30.06, P<0.000 01) and postoperative hospital stay (MD=-2.15, 95% CI -3.63--0.67, P=0.004), the differences were statistically significant.However, the operation time of the minimally invasive laparoscopic CST group was longer than that of the traditional open CST group (MD=16.13, 95% CI 2.77-29.48, P=0.02), the difference was statistically significant.

Conclusion

Compared with traditional open CST, minimally invasive laparoscopic CST has advantages in postoperative recurrence rate, postoperative complications, intraoperative blood loss and postoperative hospital stay, but its operation time is slightly longer.

Key words: Hernia, abdominal, Herniorrhaphy, Component separation technique, Laparoscopes, Meta-analysis
图1 PubMed 检索流程
表1 获取文献的一般信息
作者 发表时间 国家 研究类型 研究时间 总样本量(例) 腹腔镜组(例) 开放组(例) 文献质量评分(分)
Lowe JB 等[11] 2000 美国 回顾性研究 1994-1997 37 7 30 7
Harth KC 等[12] 2010 美国 回顾性研究 2005-2009 44 22 22 8
Albright E 等[13] 2011 美国 回顾性研究 2008-2010 25 11 14 7
Giurgius M 等[14] 2012 法国 回顾性研究 2008-2010 35 21 14 7
Fox M 等[15] 2013 美国 回顾性研究 2009-2011 44 18 26 8
Azoury SC 等[16] 2014 美国 前瞻性研究 2010.10-2013.7 76 42 34 9
Nathaniel Ng 等[17] 2015 美国 回顾性研究 2009-2013 48 10 38 7
Muse TO 等[18] 2018 美国 回顾性研究 2006.1-2011.12 170 53 117 8
Palmer DS 等[19] 2019 美国 回顾性研究 2011.11-2018.4 33 9 24 8
陈正民等[20] 2019 中国 回顾性研究 2014-2017 116 58 58 7
李冬[21] 2021 中国 回顾性研究 2015.10-2019.11 58 33 25 7
李权军[22] 2023 中国 前瞻性研究 2020.10-2022.4 68 34 34 7
表2 研究数据的基本情况
作者 手术方式 年龄(中位数) 男性 女性 体重指数(kg/m2) 缺损面积(cm2) 随访时长(个月)
Lowe JB 等[11] 腹腔镜CST 53 3 4 35.5 288 12
开放CST 45 15 15 33.2 209 12
Harth KC 等[12] 腹腔镜CST 55 13 9 36 324 14
开放CST 65 7 15 37 392 16
Albright E 等[13] 腹腔镜CST 46 5 6 37.5 - 4
开放CST 50 7 7 34.8 - 4
Giurgius M 等[14] 腹腔镜CST 51 10 11 36 255 8
开放CST 50 7 7 35 146 -
Fox M 等[15] 腹腔镜CST 57 9 9 34 - 13
开放CST 51 13 13 32 - 15
Azoury SC 等[16] 腹腔镜CST 56 15 27 34.2 120 8
开放CST 50 9 25 40.9 262.5 10
Nathaniel Ng 等[17] 腹腔镜CST 48.7 - - 37.5 102.7 15
开放CST 50.8 - - 31.3 226.9 37
Muse TO 等[18] 腹腔镜CST 54.4 21 32 35.3 313 12.7
开放CST 50.2 51 66 31.4 - 14.3
Palmer DS 等[19] 腹腔镜CST 53 5 4 32.7 108.5 5.7
开放CST 51 10 14 34.6 138.2 5
陈正民等[20] 腹腔镜CST 45 30 28 - - 6
开放CST 44 31 27 - - 6
李冬[21] 腹腔镜CST 42 19 14 - - -
开放CST 41 14 11 - - -
李权军[22] 腹腔镜CST 41 17 17 - - -
开放CST 40 18 16 - - -
图2 留存文献的筛选流程及结果
图3 腹腔镜CST 组与开放CST 组术后复发率的比较 注：CST 为组织结构分离技术。
图4 腹腔镜CST 组与开放CST 组术后并发症的比较 注：CST 为组织结构分离技术。
图5 腹腔镜CST 组与开放CST 组手术时间的比较 注：CST 为组织结构分离技术。
图6 腹腔镜CST 组与开放CST 组术中出血量的比较 注：CST 为组织结构分离技术。
图7 腹腔镜CST 组与开放CST 组术后住院时间的比较 注：CST 为组织结构分离技术。
图8 术后复发率的漏斗图
图9 术后复发率的Egger 检验图
图10 术后复发率的Begg 检验图
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