【摘要】：目的:采用Meta分析評估腹腔鏡與開放無張力疝修補術治療成人復發(fā)性腹股溝疝的療效及安全性。方法:從以下八大常用數(shù)據(jù)庫進行相關文獻的全面檢索:PubMed、EMbase、Cochrane Library、Web of Science、生物醫(yī)學、知網(wǎng)、維普和萬方數(shù)據(jù)庫,同時輔以其他檢索方法,檢索時間范圍均限定于1990年1月至2014年5月,檢索語種為中文和英文兩種。收集所有對比兩種不同手術方式治療成人復發(fā)疝的療效及安全性的隨機對照試驗(RCT)。由兩名評價員按照納入與排除標準獨立進行文獻篩選、資料提取并交叉核對,使用Cochrane協(xié)作網(wǎng)推薦軟件Rev Man 5.3版本對數(shù)據(jù)實施統(tǒng)計分析。結果:最終納入11篇RCT,共1039例病人。Meta分析結果顯示:兩種不同手術方法在腹股溝復發(fā)疝術后慢性疼痛發(fā)生率[OR=0.40,95%CI(0.20,0.82),P=0.01]、切口感染率[OR=0.28,95%CI(0.10,0.81),P=0.02]、術后恢復日常活動時間[國外:MD=-4.54,95%CI(-5.59,-3.49),P0.00001,國內(nèi):MD=-2.24,95%CI(-2.55,-1.93),P0.00001]和手術時間[MD=4.57,95%CI(2.83,6.30),P0.00001]方面的差異有統(tǒng)計學意義,而在術后再復發(fā)率[OR=0.75,95%CI(0.46,1.21),P=0.24]、急性疼痛[OR=0.74,95%CI(0.14,3.76),P=0.71]、術后血腫或血清腫[OR=0.73,95%CI(0.48,1.11),P=0.14]與尿潴留發(fā)生率[OR=0.97,95%CI(0.46,2.07),P=0.94]方面的差異均無統(tǒng)計學意義。結論:與開放無張力手術相比,腹腔鏡手術不僅可以降低腹股溝復發(fā)疝的術后慢性疼痛發(fā)生率與切口感染率,還可以縮短其術后恢復日常活動時間,但腹腔鏡手術的手術時間較長。臨床上可根據(jù)病人的具體情況及要求并結合臨床醫(yī)生的經(jīng)驗選擇最優(yōu)的再手術方法以取得良好的手術效果。
[Abstract]:Objective: to evaluate the efficacy and safety of laparoscopic and open tension-free hernioplasty for recurrent inguinal hernia in adults. Methods: the following eight common databases were used to conduct a comprehensive search for the following eight common databases: the Web of Science, Biomedicine, Web of knowledge, Weip and Wanfang databases, supplemented by other retrieval methods. The search time was limited from January 1990 to May 2014. The retrieval languages are Chinese and English. All randomized controlled trials (RCT) were conducted to compare the efficacy and safety of two different surgical procedures in the treatment of adult recurrent hernia. According to the criteria of inclusion and exclusion, two evaluators independently carried out literature screening, data extraction and cross-check, and used Cochrane Cooperative Network recommendation software Rev Man 5.3 to carry out statistical analysis of the data. Results: a total of 1039 patients with recurrent inguinal hernia were included in 11 RCTs. The results of Meta-analysis showed that two different surgical methods had a chronic pain rate after inguinal recurrent hernia [ORO 0.40% 95 CI (0.20 鹵0.82) P0.01], incision infection rate [ORO 0.28995 CI (0.100.81) P0.02], postoperative recovery time of daily activities [foreign brain MD-4.54% 95 CI (-5.59% -3.49) P 0.00001]. There were statistically significant differences in the duration of operation between the two groups (-2.55U -1.93) and operation time (2.836.30 CI (2.836.30) P0.00001). However, there was no significant difference in the recurrence rate (0.75 鹵95CI) (0.461.21), acute pain (0.143.76) CI (0.143.76) P0.71, postoperative hematoma or serum swelling (0.481.11 P0.14) and urinary retention rate (OR0.9795CI (0.462.07) P0.94). Conclusion: compared with open tension-free surgery, laparoscopic surgery can not only reduce the incidence of postoperative chronic pain and incision infection rate, but also shorten the time of daily recovery of postoperative activities in patients with recurrent inguinal hernia. But the operative time of laparoscopic surgery is longer. The optimal reoperation method can be selected according to the patient's specific condition and requirement and the clinician's experience in order to obtain good operation effect.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R656.21

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