摘要
目的:评价开放式无张力性疝修补术中预防性切除髂腹股沟神经的临床有效性及安全性。方法:检索中外数据库2017年3月之前公开发表的有关评价髂腹股沟神经切除的临床意义的随机对照试验,提取据进行Meta分析。结果:共纳入13篇文献,共2 033例患者,其中神经切除组1 007例,神经保留组1 026例。与神经保留组比较,神经切除组术后近期和中期疼痛感(SMD=-0.54,95%CI=-0.85^-0.23;SMD=-0.25,95%CI=-0.40^-0.10)均明显降低(均P<0.05),远期疼痛感(SMD=-0.21,95%CI=-0.47~0.05)差异无统计学意义(P>0.05);术后近期、中期、远期麻木率(RD=0.00,95%CI=-0.06~0.07;RD=0.01,95%CI=-0.03~0.06;RD=0.00,95%CI=-0.03~0.02)与感觉障碍率(RD=0.05,95%CI=-0.03~0.12;RD=0.02,95%CI=-0.02~0.06;RD=0.01,95%CI=-0.02~0.04)均无统计学差异(均P>0.05);术后次要并发症发生率(RR=0.71,95%CI=0.48~1.06)亦无统计学差异(P>0.05)。结论:在开放式无张力性疝修补术中预防性切除髂腹股沟神经能够有效降低术后近期、中期疼痛感,且不增加腹股沟区感觉异常的风险。
Objective： To evaluate the clinical efficacy and safety of prophylactic ilioinguinal neurectomy in open tension- free inguinal hernia repair. Methods： The randomized controlled trials estimating the clinical significance of prophylactic ilioinguinal neurectomy publically published before March 2017 were searched in several national and international databases. A meta-analysis was performed on the extracted data. Results： A total of 13 studies were included, involving 2 033 patients with 1 007 cases in nerve excision group and 1 026 cases in nerve preservation group. In nerve excision group compared nerve preservation group, the short- and mid-term postoperative pain （SMD=-0.54, 95% CI=-0.85--0.23; SMD=-0.25, 95% CI=-0.40--0.10） weresignificantly reduced （both P〈0.05）, but the long-term postoperative pain （SMD=-0.21, 95% CI=-0.47-0.05） showed no significant difference （P〉0.05）; all the short-, mid- and long-term rates of postoperative numbness （RD=0.00, 95% CI=-0.06 0.07; RD=0.01, 95% CI=-0.03 0.06; RD=0.00, 95% CI=-0.03-0.02） and sensory disturbance （RD=0.05, 95% CI=-0.03-0.12; RD=0.02, 95% CI=-0.02-0.06; RD=0.01, 95% CI=-0.02-0.04） showed no significant difference （all P〉0.05）; the incidence of minor postoperative complications （RR=0.71 95% CI=0.48-1.06） also showed no significant difference （P〉0.05）. Conclusion： Prophylactic ilioinguinal neurectomy in open inguinal hernia repair can effectively reduce the short- and mid-term painj with no increase of risk of abnormal sensations in the inguinal area.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2017年第10期1237-1246,共10页
China Journal of General Surgery
关键词
疝
腹股沟
疝修补术
腰骶丛
疼痛
META分析
Hernia, Inguinal
Herniorrhaphy
Lumbosacral Plexus
Pain
Meta-Analysis
