Lichtenstein腹股沟疝修补术中使用自固定补片与缝合补片疗效比较的Meta分析
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李航宇, Email: li_hangyu@126.com

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国家自然科学基金资助项目(81472302)。


Efficacy comparison of using self-gripping mesh and sutured mesh in Lichtenstein hernia repair: a Meta-analysis
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    摘要:

    目的: 比较自固定补片与缝合补片在Lichtenstein腹股沟疝修补术中应用的效果。
    方法: 计算机检索2010年1月—2019年1月国内外数据库中关于在Lichtenstein无张力疝修补术中应用自固定补片与缝合补片效果比较的随机对照试验(RCT)。按照纳入和排除标准筛选文献后,使用Cochrane风险偏倚评估工具进行质量评价,采用Review Manager 5.3统计学软件进行效应量的合并分析。
    结果: 最终纳入14项RCT共3 904例患者,其中自固定补片组1 930例,缝合补片组1 974例。Meta分析结果显示,与缝合补片组比较,自固定补片组的手术时间明显缩短(MD=-5.31,95% CI=-8.11~
    -2.51,P=0.000 2),术后切口感染发生率明显降低(RR=0.46,95% CI=0.26~0.81,P=0.007),但术后疝复发率较高(RR=1.67,95% CI=1.12~2.48,P=0.01)。两组患者的术后慢性腹股沟区疼痛发生率、术区异物感发生率、血肿发生率、血清肿发生率差异均无统计学意义(均P>0.05)。
    结论: 与传统缝合补片在Lichtenstein无张力修补术中应用效果相比,自固定补片具有缩短手术时间和降低术后切口感染发生率的优势,但术后短期(1年内)疝复发率可能升高,但该结论仍需更大样本高质量的研究予以验证。

    Abstract:

    Objective: To compare the application efficacy of self-gripping mesh and sutured mesh in Lichtenstein inguinal hernia repair.    
    Methods: The randomized controlled trials (RCTs) comparing using self-gripping mesh and sutured mesh in Lichtenstein tension-free mesh repair from January 2010 to January 2019 were searched in the national and international databases. After literature screening according to the inclusion and exclusion criteria, the risks of bias of included studies were assessed by the Cochrane collaboration tool, and the pooled effect size was analyzed by using of Review Manager Version 5.3 software.
    Results: Fourteen RCTs were finally included involving 3 904 patients, with 1 930 cases in self-gripping mesh group and 1 974 cases in sutured mesh group. The results of Meta-analysis showed that the operative time was significantly shortened (MD=–5.31, 95% CI=–8.11––2.51, P=0.000 2) and the wound infection rate was significantly decreased (RR=0.46, 95% CI=0.26–0.81, P=0.007) , but the hernia recurrence rate was significantly increased (RR=1.67, 95% CI=1.12–2.48, P=0.01) in self-gripping mesh group compared with sutured mesh group; there was no statistical differences in incidence of postoperative chronic groin pain, foreign body sensation, hematoma and seroma between the two groups (all P>0.05).
    Conclusion: Compared with the traditional sutured mesh in Lichtenstein tension-free repair, self-gripping mesh has the advantages of shortening operative time and reducing incidence of incision infection, but it may lead to an increased hernia recurrence in short-term postoperative period (within one year after operation). However, this conclusion still needs to be validated by large sample size and high-quality studies.

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唐世磊, 魏士博, 张德巍, 李航宇. Lichtenstein腹股沟疝修补术中使用自固定补片与缝合补片疗效比较的Meta分析[J].中国普通外科杂志,2019,28(4):478-483.
DOI:10.7659/j. issn.1005-6947.2019.04.014

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  • 收稿日期:2019-02-20
  • 最后修改日期:2019-03-15
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  • 在线发布日期: 2019-04-25