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中华疝和腹壁外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (03) : 317 -324. doi: 10.3877/cma.j.issn.1674-392X.2025.03.014

循证医学

腹腔镜与开放式补片修补术治疗复发性腹股沟疝的Meta分析
林凯1, 罗凡1, 杨春1,()   
  1. 1. 610072 成都,四川省医学科学院·四川省人民医院胃肠外科
  • 收稿日期:2023-07-07 出版日期:2025-06-18
  • 通信作者: 杨春
  • 基金资助:
    四川省科技计划-重点研发项目(2022YFS0166)

Laparoscopic vs open mesh repair for the treatment of recurrent inguinal hernia:A meta-analysis

Kai Lin1, Fan Luo1, Chun Yang1,()   

  1. 1. Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China
  • Received:2023-07-07 Published:2025-06-18
  • Corresponding author: Chun Yang
引用本文:

林凯, 罗凡, 杨春. 腹腔镜与开放式补片修补术治疗复发性腹股沟疝的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(03): 317-324.

Kai Lin, Fan Luo, Chun Yang. Laparoscopic vs open mesh repair for the treatment of recurrent inguinal hernia:A meta-analysis[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(03): 317-324.

目的

通过随机对照试验(RCT)的荟萃分析评估腹腔镜和开放式补片修补术治疗复发性腹股沟疝的疗效。

方法

对腹腔镜和开放式补片修补术治疗复发性腹股沟疝的RCT研究进行全面、系统的Meta分析。以PubMed、Embase、Science Direct、Cochrane登记的对照试验及中国国家知识基础设施(CNKI)和万方等国内外主要数据库(截至2021年12月30日)的研究为基础,为确保结果的准确性和可靠性,采用比值比或加权平均差异以及95%置信区间的固定或随机效应模型计算每个结果。

结果

共纳入10项随机对照试验,共计1034例患者。腹腔镜组和开放式补片修补组复发率(P=0.07;OR=0.61,95% CI 0.35~1.05)、血肿(P=0.16;OR=0.45,95% CI 0.14~1.38)、尿潴留(P=0.82;OR=0.92,95% CI 0.43~1.96)和急性疼痛(P=0.07,OR=1.83,95% CI 0.95~3.54)发生率、手术时间(P=0.62,MD 5.92,95% CI -17.22~29.07)差异无统计学意义。腹腔镜组切口感染率较低(P=0.03;OR=0.31,95% CI 0.11~0.91)、慢性疼痛较少(P=0.001,OR=0.36,95% CI 0.19~0.67)、住院时间较短(P=0.004;MD -1.30,95% CI -2.19~-0.42)。

结论

在切口感染、术后慢性疼痛、住院时间等方面,复发性腹股沟疝的腹腔镜手术疗效优于开放式补片修补术,这为客观评估腹腔镜与开放式补片修补术治疗复发性腹股沟疝的差异提供可靠证据,未来仍应开展高质量的腹腔镜和开放式补片修补治疗复发性腹股沟疝的相关研究,以加强结论的可靠性。

Objective

To evaluate the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia by a meta-analysis of randomized controlled trials (RCTs).

Methods

A comprehensive, systematic meta- analysis of RCTs on the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia was performed. Studies were identified by searching PUBMED, EMBASE, Science Direct, Cochrane registered controlled trials and China national knowledge infrastructure (CNKI), Wanfang, and other major domestic and foreign databases (until December 30, 2021). Summary odd ratios or weighted mean differences with 95% confidence intervals were adopted for the calculation of each outcome by fixed or random effects model.

Results

A total of 10 RCTs involving 1034 patients were included. No statistically significant difference were found between the two groups in the recurrent rate (P=0.07; OR=0.61, 95% CI 0.35-1.05), hematoma (P=0.16; OR=0.45, 95%CI 0.14-1.38), urinary retention (P=0.82; OR=0.92, 95% CI 0.43-1.96), acute pain (P=0.07, OR=1.83, 95%CI 0.95-3.54)) and operation times (P=0.62, MD 5.92, 95% CI -17.22-29.07). The laparoscopic group had lower rates of incision infection (P=0.03; OR=0.31, 95% CI 0.11-0.91), less chronic pain (P=0.001;OR=0.36, 95% CI 0.19-0.67), and shorter hospital stays (P=0.004; MD -1.30, 95% CI -2.19--0.42).

Conclusion

In terms of incisional infection, postoperative chronic pain, and hospital stay, laparoscopic surgery for recurrent inguinal hernia is superior to open mesh repair. This provides reliable evidence for the objective evaluation of the difference between laparoscopic and open mesh repair for recurrent inguinal hernias, and for the management of recurrent inguinal hernias. In the future, high-quality research on laparoscopic and open mesh repair treatments for recurrent inguinal hernia should be conducted to enhance the reliability of the conclusions.

图1 腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究筛选流程图
表1 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的特点
图2 腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的偏倚风险(2A偏倚风险图 2B偏倚总结的风险)
图3 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的复发率的森林图
图4 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的切口感染森林图
图5 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的血肿森林图
图6 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的尿潴留森林图
图7 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的急性疼痛森林图
图8 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的慢性疼痛森林图
图9 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的手术时间森林图
图10 纳入腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究的住院时间森林图
图11 腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究中复发率的漏斗图
图12 腹腔镜与开放式补片修补术治疗复发性腹股沟疝Meta分析研究中剪补后复发率的漏斗图
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