摘要
目的比较腹腔镜与开放疝囊高位结扎术治疗儿童腹股沟疝的安全性和效果。方法制定严格的纳入标准与排除标准,检索中国生物医学文献检索分析系统光盘数据库、中国期刊全文数据库、万方数据库、PubMed、EMbase等数据库,收集1987至2018年腹腔镜疝囊高位结扎术(LH)和传统疝囊高位结扎术(OH)治疗儿童腹股沟疝的随机对照试验,按照Cochrane协作网推荐的方法对纳入研究进行系统分析。结果11篇随机对照试验(1508例患者)纳入分析,LH组757例,OH组751例。LH组与OH组比较睾丸萎缩发生率[OR=0.15,95%CI(0.03~0.84),P=0.03]、术后总并发症发生率[OR=0.15,95%CI(0.08~0.26),P<0.00001]、复发率[RR=0.33,95%CI(0.18~0.62),P=0.0005]均较低。与OH组比较,双侧疝亚组,LH组的手术时间较短[MD=-8.82,95%CI(-11.80~-5.83),P<0.00001],而对于单侧疝亚组,2组的手术时间无明显差异[MD=-2.71,95%CI(-7.96~2.54),P=0.31]。恢复正常活动的时间[MD=-0.06,95%CI(-0.66~0.53),P=0.84]和止痛药物的使用剂量[MD=-0.84,95%CI(-0.36~1.93),P=0.55],组间均无明显差异。结论Meta分析显示,LH较OH有明显的优势,特别是减少术后并发症及疝复发方面,但仍需要高质量的随机对照试验进一步支持。
Objective To analyze the safety and efficacy of laparoscopic herniorrhaphy(LH)compared with open high ligation of the hernia sac herniorrhaphy(OH)in children.Methods Strict inclusion and exclusion criteria were set up.Databases including CBMdisc,CNKI,Wanfang,PubMed and EMbase were searched.All the randomized controlled trials(RCT)on LH and OH for inguinal hernia from 1987 to 2018 were collected.Systematical analysis was performed according to the recommendation by the Cochrane handbook.Results Eleven RCTs including 1508 patients were included in the analysis.They were divided into LH group(n=757)and OH group(n=751).Rate of testicular atrophy[OR=0.15,95%CI(0.03,0.84),P=0.03],total complications[OR=0.15,95%CI(0.08,0.26),P<0.00001]and recurrence[RR=0.33,95%CI(0.18,0.62),P=0.0005]were significantly lower in LH group compared to OH group.Compared with OH group,the operative time was significantly shorter in LH group for bilateral hernia repairs[MD=-8.82,95%CI(-11.80,-5.83),P<0.00001].There was no difference between the two groups regarding operative time for unilateral hernia repairs[MD=-2.71,95%CI(-7.96,2.54),P=0.31].There were no significant differences in the time before full activity[MD=-0.06,95%CI(-0.66,0.53),P=0.84]and analgetic dosage[MD=-0.84,95%CI(-0.361.93),P=0.55]between the two groups.Conclusion In this meta-analysis,LH showed obvious advantages over OH,especially in reducing postoperative complications and recurrence.However,more high quality RCTs were needed to further supported it.
作者
薛小军
锜和强
屈振南
钟伟
李冉冉
陈宇凡
周松
Xiaojun Xue;Heqiang Qi;Zhennan Qu;Wei Zhong;Ranran Li;Yufan Chen;Song Zhou(Department of General Surgery,the 909th Hospital of PLA(the Southeast Affiliated Hospital of Xiamen University),Zhangzhou 363000,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2022年第5期587-594,共8页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
疝
腹股沟
腹腔镜
疝修补术
儿童
随机对照试验
META分析
Hernia
inguinal
Laparoscopes
Herniorrhaphy
Children
Randomized controlled trial
Meta-analysis
