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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) ›› 2026, Vol. 20 ›› Issue (05) : 563 -581. doi: 10.3877/cma.j.issn.1674-392X.2026.05.015

循证医学

单孔与传统三孔腹腔镜完全腹膜外疝修补术疗效比较的Meta分析
祝轲1, 吕小涵2, 来比江·吾斯曼3, 王文锋3, 张文斌3, 闵敏4,†()   
  1. 1834000　新疆维吾尔自治区，克拉玛依市中心医院普外中心
    4834000　新疆维吾尔自治区，克拉玛依市中心医院临检中心
    2834000　新疆维吾尔自治区，克拉玛依市中西医结合医院感染管理科
    3830011　乌鲁木齐，新疆医科大学附属肿瘤医院胃肠外科
  • 收稿日期:2024-09-07 出版日期:2026-10-18
  • 通信作者: 闵敏
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2022D01D77); 克拉玛依市中心医院院内项目(20250408)

The efficacy of single-incision versus conventional three-port laparoscopic totally extra-peritoneal hernia repair: a meta-analysis

Ke Zhu1, Xiaohan Lyu2, Wusiman Laibijiang3, Wenfeng Wang3, Wenbin Zhang3, Min Min4,†()   

  1. 1General Surgery Center, Karamay Central Hospital, Karamay 834000, Xinjiang Uygur Autonomous Region, China
    4Clinical Laboratory Center, Karamay Central Hospital, Karamay 834000, Xinjiang Uygur Autonomous Region, China
    2Department of Infection Management, Karamay Hospital of Integrated Traditional Chinese and Western Medicine, Karamay 834000, Xinjiang Uygur Autonomous Region, China
    3Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China
  • Received:2024-09-07 Published:2026-10-18
  • Corresponding author: Min Min
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引用本文：

祝轲, 吕小涵, 来比江·吾斯曼, 王文锋, 张文斌, 闵敏. 单孔与传统三孔腹腔镜完全腹膜外疝修补术疗效比较的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(05): 563-581.

Ke Zhu, Xiaohan Lyu, Wusiman Laibijiang, Wenfeng Wang, Wenbin Zhang, Min Min. The efficacy of single-incision versus conventional three-port laparoscopic totally extra-peritoneal hernia repair: a meta-analysis[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(05): 563-581.

目的

比较单孔腹腔镜完全腹膜外疝修补术（SIL-TEP）与传统三孔腹腔镜完全腹膜外疝修补术（CL-TEP）的疗效与安全性。

方法

计算机检索PubMed、Cochrane Library、Web of Science、中国知网、万方数据库和维普期刊数据库中比较SIL-TEP与CL-TEP的随机对照试验（RCT）和临床对照研究（CCT），检索时限为建库至2024年7月。由2名研究者根据纳入与排除标准独立进行文献筛选、资料提取和质量评价，采用RevMan 5.4及Stata 18.0 MP软件进行Meta分析。

结果

共纳入研究28项，其中RCT 10项，CCT 18项，共2939例患者（SIL-TEP组1542例，CL-TEP组1397例）。2组患者年龄、体重指数比较，差异均无统计学意义（P>0.05）。SIL-TEP组单侧手术时间更长（MD=6.22，95% CI 2.07~10.37；P=0.003）；双侧手术时间在剔除2项异质性来源研究后更长（MD=7.88，95% CI 4.08~11.69；P<0.0001），但纳入全部研究时差异无统计学意义（P=0.08）；切口满意度评分更高（SMD=0.21，95% CI 0.03~0.39；P=0.02）；术后24 h疼痛程度低（SMD=－0.59，95% CI －0.93~－0.26；P=0.0005）；术后皮下气肿发生率较低（RR=0.20，95% CI 0.04~0.99；P=0.05，仅2项研究报道）；2组术中出血量、术后住院时间、术后恢复正常活动时间及术后并发症发生率差异均无统计学意义（均P>0.05）。

结论

与CL-TEP相比，SIL-TEP具有相当的安全性和可行性，术后疼痛较轻、切口更美观，皮下气肿发生率可能较低，但单侧手术时间更长，双侧手术时间亦可能延长。对美观和疼痛要求较高的简单疝患者可选择SIL-TEP，高龄或复杂疝等需控制手术时间的患者应慎重选择。

关键词: 疝，腹股沟, 腹腔镜, 单孔, 三孔, 完全腹膜外疝修补术, 荟萃分析
Objective

To compare the efficacy and safety of single-incision laparoscopic totally extra-peritoneal hernia repair (SIL-TEP) and conventional three-port laparoscopic totally extra-peritoneal hernia repair (CL-TEP).

Methods

PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Journal Database were searched from the establishment of the databases to July 2024, for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing SIL-TEP with CL-TEP. Two reviewers independently performed literature screening, data extraction and quality assessment according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 and Stata 18.0 MP.

Results

A total of 28 studies were included, comprising 10 RCTs and 18 CCTs, involving 2939 patients (1542 in the SIL-TEP group and 1397 in the CL-TEP group). There were no statistically significant differences in age or body mass index between the two groups (P>0.05). The SIL-TEP group had a longer operation time for unilateral hernias (MD=6.22, 95% CI 2.07-10.37; P=0.003); and a longer operation time for bilateral hernias after excluding two studies contributing to heterogeneity (MD=7.88, 95% CI 4.08-11.69; P<0.0001), but the difference was not statistically significant when all studies were included (P=0.08). The SIL-TEP group also had a higher incision satisfaction score (SMD=0.21, 95% CI 0.03-0.39; P=0.02), a lower pain score at 24 h after surgery (SMD=-0.59, 95% CI -0.93--0.26; P=0.0005), and a lower incidence of postoperative subcutaneous emphysema (RR=0.20, 95% CI 0.04-0.99; P=0.05; reported in only two studies). There were no significant differences in intraoperative blood loss, postoperative hospital stays, time to return to normal activities or the incidence of postoperative complications between the two groups (all P>0.05).

Conclusions

Compared with CL-TEP, SIL-TEP has comparable safety and feasibility, with less postoperative pain, better incision cosmesis, and the incidence of subcutaneous emphysema may be lower. However, it requires a longer operation time for unilateral hernias, and operation time may also be prolonged for bilateral hernias. SIL-TEP may be chosen for patients with uncomplicated hernias who have high demands regarding cosmesis and pain relief. It should be chosen with caution when the operation time needs to be controlled, such as in elderly patients or those with complex hernias.

Key words: Hernia, inguinal, Laparoscopes, Single-incision, Three-port, Totally extra- peritoneal hernia repair, Meta-analysis
图1 文献筛选流程图
图2 纳入RCT的偏倚风险总结图注：RCT为随机对照试验。绿色、黄色、红色分别表示低、未知、高偏倚风险。
图3 纳入RCT的偏倚风险比例图注：RCT为随机对照试验。
表1 纳入28项研究的基本特征
第一作者(年份) 国家/地区 研究类型 补片固定 SIL-TEP组 CL-TEP组 术后并发症 NOS评分(分)
例数(单侧/双侧) 年龄(岁,±s) BMI(kg/m2,±s) 随访时间(月) 例数(单侧/双侧) 年龄(岁,±s) BMI(kg/m2,±s) 随访时间(月)
Bialecki(2014)[13]a 波兰 RCT 未固定 35 58.2±12.1 - 3 26 57.8±12.9 - 3 - -
Bialecki(2020)[14]a 波兰 RCT 未固定 17 50.2±18.6 - - 17 49.0±14.2 - - - -
Cardinali(2018)[15]a 比利时 RCT 螺旋钉 113(84/29) 49.0±17.8 24.9±4.7 28.4(13~41) 97(76/21) 55.0±17.8 24.6±6.6 26.4(13~41) - -
Chia(2020)[16] 新加坡 RCT 可吸收钉 42 57.3±13.8 24.4±3.4 >28 41 54.4±15.3 24.3±3.1 >28 DGIJK -
Choi(2016)[17] 韩国 RCT 螺旋钉 50 57.5±17.2 23.4±2.9 20 49 59.5±15.2 23.1±2.2 20 ADFI -
Tran(2014)[18]a 澳大利亚 RCT 不吸收钉 51(21/30) 48.0±13.3 25.0±4.7 6~21 49(20/29) 52.0±17.8 26.0±4.0 6~21 - -
Tsai(2013)[19]a 中国台湾 RCT 生物钉 50 55.4±15.1 23.5±3.0 5.9±0.4 50 53.2±17.2 24.5±2.8 6.0±0.0 - -
Wijerathne(2014)[20] 新加坡 RCT 可吸收钉 26 46.0±11.0 22.6±2.8 6 24 45.0±12.0 23.2±3.1 6 DK -
Wijerathne(2016)[21] 新加坡 RCT 螺旋钉 49 47.2±14.9 24.3±3.4 6 50 50.3±13.8 24.2±2.9 6 DK -
XuenLi(2024)[22] 中国 RCT 未固定 66(50/16) 63.8±10.5 26.6±5.1 ≥12 61(51/10) 66.5±9.6 26.8±4.9 ≥12 ADHI -
王建锋(2023)[23] 中国 回顾性 自固定 15 53.1±15.1 24.1±2.0 - 15 56.7±13.4 23.1±2.5 - BCD 8
Suzuki(2022)[24]a 日本 回顾性 可吸收钉 149(128/21) 62.6±10.5 22.5±2.3 66(36~70) 37(32/5) 67.9±11.6 23.3±3.5 65(37~68) - 8
刘家惠(2022)[25] 中国 回顾性 医用胶 30 54.4±13.8 - - 30 51.5±10.6 - - DEF 8
Lee(2021)[26] 韩国 回顾性 螺旋钉 23 64.0±15.6 25.0±8.7 - 140 58.2±17.0 23.2±2.9 - ADFK 6
南兵(2021)[27] 中国 回顾性 - 41 48.7±5.5 - - 41 48.7±5.6 - - ADEF 7
Chueh(2020)[28] 中国台湾 回顾性 螺旋钉 62(29/33) 60.5±12.6 23.9±2.7 28±15 72(36/36) 58.5±13.5 23.7±3.5 28±15 DFIJK 8
刘文超(2020)[29] 中国 回顾性 缝合 41 46.2±8.1 - - 41 45.7±7.3 - - AD 6
张海强(2020)[30] 中国 前瞻性 未固定 47 56.7±11.3 25.0±1.8 - 47 55.2±11.2 24.9±1.4 - AD 7
Rajapandian(2018)[31] 印度 前瞻性 缝合 36(12/24) 46.4±12.5 23.5±3.1 12 36(12/24) 45.4±13.1 24.8±3.5 12 DI 7
Han(2017)[32]a 韩国 回顾性 未固定 120(112/8) 60.4±13.7 23.2±2.4 - 60(54/6) 63.7±13.4 22.9±3.1 - - 6
Wakasugi(2015)[33] 日本 回顾性 螺旋钉 100(88/12) 65.0±12.0 23.0±3.0 18±7 37(32/5) 61.0±14.0 24.0±3.0 32±8 ADIK 7
Buckley(2014)[34] 美国 回顾性 未固定 129(86/43) 55.6±17.9 26.3±4.3 6 76(29/47) 55.0±18.2 26.7±4.4 6 ADFGHI 7
de Araújo(2014)[35] 巴西 前瞻性 钛钉 26(14/12) 56.5±3.5 25.1±2.0 15.5±3.4 24(10/14) 57.7±3.3 25.7±2.3 25.5±4.4 DK 7
Kim(2013)[36] 韩国 回顾性 螺旋钉 76 59.9±13.2 23.6±2.2 - 93 59.5±13.5 23.7±2.4 - ADF 6
Cugura(2012)[37]a 克罗地亚 前瞻性 不详 22(19/3) 58.5±17.2 - 11.5±2.5 22(15/7) 55.0±20.1 - 11.0±1.6 - 8
Tai(2011)[38] 中国台湾 回顾性 螺旋钉 54(11/43) 46.9±13.6 24.6±2.9 8.7 85(18/67) 56.4±14.0 25.2±3.7 11 BDFI 7
Sherwinter(2010)[39] 美国 回顾性 不详 52(43/9) 37.5±11.9 24.8±5.3 1 52(39/13) 33.7±11.3 25.6±5.3 1 DFI 6
丁锐(2010)[40] 中国 回顾性 - 20 60.3±17.0 23.3±2.0 3.2±1.1 25 59.2±12.4 23.6±1.9 4.2±0.9 DEI 6
图4 年龄比较森林图注：(1)(2)原始数据为中位数及极差，按文献[9,10,11]方法转换为均数和标准差后纳入。
图5 体重指数比较森林图注：(1)原始数据为中位数及四分位距，按文献[9,10,11]方法转换为均数和标准差后纳入。
图6 单侧手术时间比较森林图注：Random为随机效应模型；Tau2为研究间方差。
图7 单侧手术时间Galbraith图
图8 单侧手术时间Baujat图
图9 单侧手术时间敏感性分析
图10 单侧手术时间亚组分析
图11 双侧手术时间森林图
图12 双侧手术时间Galbraith图
图13 双侧手术时间Baujat图
图14 双侧手术时间敏感性分析
图15 双侧手术时间亚组分析
图16 切口满意度评分Baujat图
图17 切口满意度评分森林图注：SMD为标准化均数差。
图18 术中出血量Baujat图
图19 术中出血量森林图
图20 术后住院时间森林图
图21 术后恢复正常活动时间Baujat图
图22 术后恢复正常活动时间森林图
图23 术后24 h疼痛评分敏感性分析
图24 术后24 h疼痛评分森林图
图25 术后并发症森林图注：RR为相对危险度；M-H为Mantel-Haenszel法；Events为事件数。
图26 术后并发症亚组分析森林图
图27 术后并发症漏斗图
表2 SIL-TEP组与CL-TEP组术后并发症比较Meta结果
并发症 SIL-TEP组发生率(%) CL-TEP组发生率(%) 异质性检验 Meta分析结果RR(95% CI) Z值 P值
I2(%) P值
切口感染 0.71 1.25 16 0.31 0.83 (0.38,1.84) 0.45 0.65
皮下气肿 0.10 0.77 0 0.5 0.2 (0.04,0.99) 1.97 0.05
脂肪液化 0.00 0.10 NA NA 0.33 (0.01,7.58) 0.69 0.49
术后血肿、血清肿 5.79 6.35 0 0.94 0.89 (0.63,1.26) 0.65 0.52
浆液肿 0.30 0.29 0 0.49 1.12 (0.23,5.46) 0.14 0.89
尿潴留 2.13 2.50 0 0.81 0.78 (0.45,1.36) 0.86 0.39
慢性疼痛 0.71 0.58 0 0.63 0.76 (0.26,2.25) 0.49 0.62
切口疝 0.10 0.00 NA NA 1.78 (0.07,43.08) 0.35 0.72
睾丸炎、睾丸萎缩 0.10 0.38 NA NA 0.29 (0.03,2.53) 1.12 0.26
复发 1.22 0.96 0 0.65 1.13 (0.54,2.37) 0.32 0.75
其他 1.42 1.44 0 0.97 1.24 (0.60,2.60) 0.58 0.56
图28 Begg漏斗图
图29 Egger检验图
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