成人腹股溝疝無張力修補術隨機對照試驗的Meta分析_《中國循證醫學雜志》

作者：

周建平 , 劉祺

中南大學湘雅二醫院老年外科,長沙,410011;

關鍵詞：

無張力疝修補術 Meta分析

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目的　評價各種成人腹股溝疝無張力修補術式的臨床療效.
方法　電子檢索中國學術期刊網全文數據庫(CNKI)(1993 2003).美國OVID數據庫(1993 2003)和MEDLINE(1993～2003),與研究者聯系以獲得更多相關研究資料.納入比較兩種不同術式行無張力疝修補,并觀察兩組患者術后復發率、圍手術期并發癥和遠期并發癥發生情況的隨機對照研究.由兩名評價員獨立收集數據并對收集所得數據及試驗質量進行評價,采用Cochrane協作網專用軟件RevMan 4.2版進行統計分析.
結果　1993年至2003年共有21個試驗,4154例患者符合納入標準.Meta分析結果提示:與平片修補術相比較,疝環充填式無張力疝修補術在術后復發率[OR 1.14,95%CI(0.37,3.47),P=0.82]、圍手術期并發癥發生率[OR1.01,95%CI(0.63,1.63),P=0 95]、遠期并發癥發生率[OR 0.46,95%CI(0.18,1.16),P=0.1]方面均無統計學差異.腹腔鏡手術亞組分析提示:經腹腔腹膜外修補術組在術后復發率[OR1.24,95%CI(0.65,2.36),P=0 52]、圍手術期并發癥[OR 0.89,95%CI(0 65,1.22),P=0.46]和術后持續疼痛[OR 0.76,95%CI(0.鈣,1.19),P=0 22]方面與開放修補術比較,無統計學差異;全腹膜外補片植入術組在復發[OR1.07,95%CI(0.51,.24),P=0.70]和術后持續疼痛[OR 0.95,95%CI(0.55,1 65),P=0.86]方面與開放修補術比較無差異,但在圍手術期并發癥[OR0.5095%CI(0.34,0.73),P=0.0004]方面則差異有統計學意義.
結論　目前的研究資料顯示,前路平片法與疝環充填式無張力修補術治療腹股溝疝的療效無明顯差別;腹腔鏡手術TEP術式較開放式疝修補術在圍手術期并發癥方面有明顯的優勢,而復發率和術后持續性疼痛方面還需要進-步研究.

引用本文： 周建平,劉祺. 成人腹股溝疝無張力修補術隨機對照試驗的Meta分析. 中國循證醫學雜志, 2005, 05(4): 303-310. doi: 復制

1.	方仲雄,唐健雄,陳革,黃磊,周軼群,王巍,戴松林.疝環充填式與平片無張力疝修補術在治療老年腹股溝疝中的比較[J]老年醫學與保健,2001;7(2):75～76.
2.	龍延濱,邱健,楊德慶,王小強,李國威.疝環充填式與平片式無張力疝修補術治療腹股溝疝的臨床比較研究[J]外科理論與實踐,2002;7(6):454～458.
3.	王堅,吳志勇.疝環充填式與平片無張力疝修補近期隨訪研究[J]外科理論與實踐,2002;7(6):448～450.
4.	李晉忠,孫立中,劉京山,趙期康兩種無張力疝修補術185例臨床分析[J]中國冶金工業醫學雜志,2002;19(2):98～99.
5.	周建平,李鐵鋼,范丹鳳.Prolene網片在成人腹股溝疝前路修補中的應用[J].中國普通外科雜志,2002;11(8):499～500.
6.	周建平,李鐵鋼,余丹,姚宏亮,范丹鳳.181例腹股溝疝普理靈網片前路修補經驗[J]外科理論與實踐,2002;7(6):440～442.
7.	楊峰,莫立顯,石大洋,陳茂榮腹股溝疝無張力修補的術式選擇[J].腹部外科,2003;16(4):241 242.
8.	Clarke M, Oxman AD, editors. Cochrane Reviews’ Handbook 4.0[ updated July 1999 ]; Section 6. In: The Cochrane Library[ database on CD-ROM ]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issue1.
9.	Aldeson P,Green S, Higgins JPT editors. Cochrane Reviews’ Handbook 4.2.2[ Updated December 2003] [M/CD]. In: The Cochrane Library, Issue 1,2004. Chichester,UK:John Wiley & Sons, Ltd.
10.	Fang ZX, Tang JX, Chen G, Huang L, Zhou YQ, Wang W, Dai SL. Comparative study of plug&nesh and only patch tension free hernioplasty in treating the groin herrna in elderly [J]. Geriatric Health Care, 2001; 7(2): 75-76.
11.	Long YB, Qiu J, Yang DQ, Wang XQ, Li GW. A clinical study on mesh plug and only mesh hernioplasty [J]. Surgical Concepts and Practices, 2002, 7(6): 454 - 458.
12.	Wang J, Wu ZY. A follow-up study on groin hernias treated by the use ofplug&nesh and mesh only[J]. Surgical Concepts and Practices,2002; 7(6): 448 - 450.
13.	Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B,Anderberg B. Tension-free inguinal hernia repair: TEP versus meshplug versus Lichtenstein: a prospective randomized controlled trial [J]. Ann Surg. , 2003; 237(1): 142 -147.
14.	Li JZ, Sun LZ, Liu JS, Zhao QK. A clinical study of two kinds of tension free hernioplasty about 185 cases report[J]. Chinese Medical Journal of Metallurgical Industry, 2002; 19(2): 98 - 99.
15.	Sarli L, Pietra N, Choua O, Costi R, Thenasseril B, Giunta A. Prospective randomised comparative study oflaparoscopic hernioplasty and Lichtenstein tension-free hernioplasty (Italian) [J ]. Acta Biomed Ateneo Parmense, 1997; 68(1 -2) :5 -10.
16.	Paganini AM, Lezoche E, Carle F, Carlei F, Favretti F, Feliciotti F,Gesuita R, Guerrieri M, Lomanto D, Nardovino M, Panti M,Ribichini P, Sarli L, Sottili M, Tamburini A, Taschieri A. A randomized, controlled, clinical study of laparoscopic vs open tensionfree hernia repair[J]. Surg Endosc,1998; 12(7): 979 - 986.
17.	Heikkinen T, Haukipuro K, Hnlkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit[J]. SurgEndosc, 1998; 12(10): 1 199-1 203.
18.	Aitola P, Airo I, Matikainen M. Laparoscopic versus open preperitoheal inguinal hernia repair: A prospective randomised trial [J]. Ann Chir, 1998; 87(1): 22-25.
19.	Koninger JS, Oster M, Butters M. Management of inguinal hernia: a comparison of current methods (German) [J]. Chirurg, 1998; 69(12): 1340-1344.
20.	Zieren J, Zieren HU, Said S, Wenger FA, Muller JM. Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’ s operation [J]. Am J Surg, 1998;175(4): 330-333.
21.	Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G. Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial[J]. Surg Endosc, 1999; 13(4): 323 - 327.
22.	Johansson B, Hallerbaock B, Glise H, Anesten B, Smedberg S, Roman J. Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair. A randomized multicenter trial (SCUR hernia repair study) [J]. Ann Surg, 1999; 230(2): 225-231.
23.	Sarli L, Iusco DR, Sansebastiano G, Costi R. Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open,tension-free versus laparoscopic approach [J]. Surgical Laparoscopy,Endoscopy&Percutaneous Techniques, 2001; 11 (4): 262 - 267.
24.	Payne J, Izawa M, Glen P, Grininger L, Podoll E, Balfour J. Laparoscopic or tension-free inguinal hernia repair.? A cost benefit analysis of 200 prospective randomized patients [Z]. In: SAGES, Philadelphia, Pennsylvania: 1996.
25.	Champault GG, Rizk N, CathelineJM, Turner R, Boutelier P. Inguinal hernia repair. Totally preperitoneal laparoscopic approach versus Stoppa operation: Randomized trial of 100 cases [J]. Surg Laparosc Endosc,1997; 7(6): 445 -450.
26.	Bostanci BE, Tetik C, Ozer S, Ozden A. Posterior approaches in groin hernia repair with prosthesis: open or closed [J]. Acta Chir Belg,1998; 98(6): 241-244.
27.	Khoury N. A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: A study of 315 cases [J]. Journal of Laparoendoscopic&Advanced Surgica Techniques,1998; 8(6): 367-372.
28.	Wright D, Paterson C, Scott N, Hair A, Patrick J. Five-year followup of patients undergoing laparoscopic or open groin hernia repair, a randomized controlled trial [J]. Annals of Surgery, 2002; 235 (3):333-337.
29.	Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic lotally extraperitoneal approach with open mesh repair in inguinal hernia[J]. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2003; 13(3): 191-195.
30.	The MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic versus open repair of groin hernia: a randomized comparison[J]. Lancet,1999; 354(7): 185-190.
31.	Rutkow IM, R obbins AW. "Tension-free" inguinal herniorrhaphy:a preliminary report on the "mesh plug" technique [J]. Surgery,1993, 114(1): 3-8.
32.	Lichtenstein IL,Am id PK, Shulman AG, Montllor MM. The tension-free hernioplasty[J]. Am J Surg, 1989; 157(2): 188-193.
33.	Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992; 35(2): 209-212.
34.	McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg Endosc. 1993;7(1): 26-28.
35.	Zhou JP, Li TG, Fan DF. The appliance ofprolene mesh in adult inguinal hernia anterior approach repair [J]. Chinese General Surgery,2002; 11 (8): 499 - 500.
36.	Zhou JP, Li TG, Yu D, Yao HL, Fan DF. Experience in 181 cases of hernioplasty with prolene mesh [J]. Surgical Concepts and Practices, 2002; 7 (6): 440 - 442.
37.	The EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh, Meta-analysis of randomized controlled trials[J]. Ann Surg, 2002; 235 (3): 322 - 332.
38.	Hung L, Nivritti GP, Francis CWL. Systematic review and rmcta-analysis of clinical trials comparing endoscopic totally extraperitoneal inguinal hernioplasty with open repair of inguinal hernia[J]. Ann. Coll.Surg. H.K, 2003; 7(1): 2-10.
39.	Yang F, Mo LX, Shi DY, Chen MR. The choice of surgical style of tension free repair of inguinal hernia[J]. Abdominal Surgery, 2003;16(4): 241 -242.

1. 方仲雄,唐健雄,陳革,黃磊,周軼群,王巍,戴松林.疝環充填式與平片無張力疝修補術在治療老年腹股溝疝中的比較[J]老年醫學與保健,2001;7(2):75～76.
2. 龍延濱,邱健,楊德慶,王小強,李國威.疝環充填式與平片式無張力疝修補術治療腹股溝疝的臨床比較研究[J]外科理論與實踐,2002;7(6):454～458.
3. 王堅,吳志勇.疝環充填式與平片無張力疝修補近期隨訪研究[J]外科理論與實踐,2002;7(6):448～450.
4. 李晉忠,孫立中,劉京山,趙期康兩種無張力疝修補術185例臨床分析[J]中國冶金工業醫學雜志,2002;19(2):98～99.
5. 周建平,李鐵鋼,范丹鳳.Prolene網片在成人腹股溝疝前路修補中的應用[J].中國普通外科雜志,2002;11(8):499～500.
6. 周建平,李鐵鋼,余丹,姚宏亮,范丹鳳.181例腹股溝疝普理靈網片前路修補經驗[J]外科理論與實踐,2002;7(6):440～442.
7. 楊峰,莫立顯,石大洋,陳茂榮腹股溝疝無張力修補的術式選擇[J].腹部外科,2003;16(4):241 242.
8. Clarke M, Oxman AD, editors. Cochrane Reviews’ Handbook 4.0[ updated July 1999 ]; Section 6. In: The Cochrane Library[ database on CD-ROM ]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issue1.
9. Aldeson P,Green S, Higgins JPT editors. Cochrane Reviews’ Handbook 4.2.2[ Updated December 2003] [M/CD]. In: The Cochrane Library, Issue 1,2004. Chichester,UK:John Wiley & Sons, Ltd.
10. Fang ZX, Tang JX, Chen G, Huang L, Zhou YQ, Wang W, Dai SL. Comparative study of plug&nesh and only patch tension free hernioplasty in treating the groin herrna in elderly [J]. Geriatric Health Care, 2001; 7(2): 75-76.
11. Long YB, Qiu J, Yang DQ, Wang XQ, Li GW. A clinical study on mesh plug and only mesh hernioplasty [J]. Surgical Concepts and Practices, 2002, 7(6): 454 - 458.
12. Wang J, Wu ZY. A follow-up study on groin hernias treated by the use ofplug&nesh and mesh only[J]. Surgical Concepts and Practices,2002; 7(6): 448 - 450.
13. Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B,Anderberg B. Tension-free inguinal hernia repair: TEP versus meshplug versus Lichtenstein: a prospective randomized controlled trial [J]. Ann Surg. , 2003; 237(1): 142 -147.
14. Li JZ, Sun LZ, Liu JS, Zhao QK. A clinical study of two kinds of tension free hernioplasty about 185 cases report[J]. Chinese Medical Journal of Metallurgical Industry, 2002; 19(2): 98 - 99.
15. Sarli L, Pietra N, Choua O, Costi R, Thenasseril B, Giunta A. Prospective randomised comparative study oflaparoscopic hernioplasty and Lichtenstein tension-free hernioplasty (Italian) [J ]. Acta Biomed Ateneo Parmense, 1997; 68(1 -2) :5 -10.
16. Paganini AM, Lezoche E, Carle F, Carlei F, Favretti F, Feliciotti F,Gesuita R, Guerrieri M, Lomanto D, Nardovino M, Panti M,Ribichini P, Sarli L, Sottili M, Tamburini A, Taschieri A. A randomized, controlled, clinical study of laparoscopic vs open tensionfree hernia repair[J]. Surg Endosc,1998; 12(7): 979 - 986.
17. Heikkinen T, Haukipuro K, Hnlkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit[J]. SurgEndosc, 1998; 12(10): 1 199-1 203.
18. Aitola P, Airo I, Matikainen M. Laparoscopic versus open preperitoheal inguinal hernia repair: A prospective randomised trial [J]. Ann Chir, 1998; 87(1): 22-25.
19. Koninger JS, Oster M, Butters M. Management of inguinal hernia: a comparison of current methods (German) [J]. Chirurg, 1998; 69(12): 1340-1344.
20. Zieren J, Zieren HU, Said S, Wenger FA, Muller JM. Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’ s operation [J]. Am J Surg, 1998;175(4): 330-333.
21. Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G. Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial[J]. Surg Endosc, 1999; 13(4): 323 - 327.
22. Johansson B, Hallerbaock B, Glise H, Anesten B, Smedberg S, Roman J. Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair. A randomized multicenter trial (SCUR hernia repair study) [J]. Ann Surg, 1999; 230(2): 225-231.
23. Sarli L, Iusco DR, Sansebastiano G, Costi R. Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open,tension-free versus laparoscopic approach [J]. Surgical Laparoscopy,Endoscopy&Percutaneous Techniques, 2001; 11 (4): 262 - 267.
24. Payne J, Izawa M, Glen P, Grininger L, Podoll E, Balfour J. Laparoscopic or tension-free inguinal hernia repair.? A cost benefit analysis of 200 prospective randomized patients [Z]. In: SAGES, Philadelphia, Pennsylvania: 1996.
25. Champault GG, Rizk N, CathelineJM, Turner R, Boutelier P. Inguinal hernia repair. Totally preperitoneal laparoscopic approach versus Stoppa operation: Randomized trial of 100 cases [J]. Surg Laparosc Endosc,1997; 7(6): 445 -450.
26. Bostanci BE, Tetik C, Ozer S, Ozden A. Posterior approaches in groin hernia repair with prosthesis: open or closed [J]. Acta Chir Belg,1998; 98(6): 241-244.
27. Khoury N. A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: A study of 315 cases [J]. Journal of Laparoendoscopic&Advanced Surgica Techniques,1998; 8(6): 367-372.
28. Wright D, Paterson C, Scott N, Hair A, Patrick J. Five-year followup of patients undergoing laparoscopic or open groin hernia repair, a randomized controlled trial [J]. Annals of Surgery, 2002; 235 (3):333-337.
29. Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic lotally extraperitoneal approach with open mesh repair in inguinal hernia[J]. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2003; 13(3): 191-195.
30. The MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic versus open repair of groin hernia: a randomized comparison[J]. Lancet,1999; 354(7): 185-190.
31. Rutkow IM, R obbins AW. "Tension-free" inguinal herniorrhaphy:a preliminary report on the "mesh plug" technique [J]. Surgery,1993, 114(1): 3-8.
32. Lichtenstein IL,Am id PK, Shulman AG, Montllor MM. The tension-free hernioplasty[J]. Am J Surg, 1989; 157(2): 188-193.
33. Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992; 35(2): 209-212.
34. McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg Endosc. 1993;7(1): 26-28.
35. Zhou JP, Li TG, Fan DF. The appliance ofprolene mesh in adult inguinal hernia anterior approach repair [J]. Chinese General Surgery,2002; 11 (8): 499 - 500.
36. Zhou JP, Li TG, Yu D, Yao HL, Fan DF. Experience in 181 cases of hernioplasty with prolene mesh [J]. Surgical Concepts and Practices, 2002; 7 (6): 440 - 442.
37. The EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh, Meta-analysis of randomized controlled trials[J]. Ann Surg, 2002; 235 (3): 322 - 332.
38. Hung L, Nivritti GP, Francis CWL. Systematic review and rmcta-analysis of clinical trials comparing endoscopic totally extraperitoneal inguinal hernioplasty with open repair of inguinal hernia[J]. Ann. Coll.Surg. H.K, 2003; 7(1): 2-10.
39. Yang F, Mo LX, Shi DY, Chen MR. The choice of surgical style of tension free repair of inguinal hernia[J]. Abdominal Surgery, 2003;16(4): 241 -242.

《中國循證醫學雜志》

成人腹股溝疝無張力修補術隨機對照試驗的Meta分析

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《中國循證醫學雜志》

成人腹股溝疝無張力修補術隨機對照試驗的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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