• 中南大學(xué)湘雅二醫(yī)院老年外科,長(zhǎng)沙,410011;

目的 　評(píng)價(jià)各種成人腹股溝疝無張力修補(bǔ)術(shù)式的臨床療效.
方法 　電子檢索中國學(xué)術(shù)期刊網(wǎng)全文數(shù)據(jù)庫(CNKI)(1993 2003).美國OVID數(shù)據(jù)庫(1993 2003)和MEDLINE(1993～2003),與研究者聯(lián)系以獲得更多相關(guān)研究資料.納入比較兩種不同術(shù)式行無張力疝修補(bǔ),并觀察兩組患者術(shù)后復(fù)發(fā)率、圍手術(shù)期并發(fā)癥和遠(yuǎn)期并發(fā)癥發(fā)生情況的隨機(jī)對(duì)照研究.由兩名評(píng)價(jià)員獨(dú)立收集數(shù)據(jù)并對(duì)收集所得數(shù)據(jù)及試驗(yàn)質(zhì)量進(jìn)行評(píng)價(jià),采用Cochrane協(xié)作網(wǎng)專用軟件RevMan 4.2版進(jìn)行統(tǒng)計(jì)分析.
結(jié)果 　1993年至2003年共有21個(gè)試驗(yàn),4154例患者符合納入標(biāo)準(zhǔn).Meta分析結(jié)果提示:與平片修補(bǔ)術(shù)相比較,疝環(huán)充填式無張力疝修補(bǔ)術(shù)在術(shù)后復(fù)發(fā)率[OR 1.14,95%CI(0.37,3.47),P=0.82]、圍手術(shù)期并發(fā)癥發(fā)生率[OR1.01,95%CI(0.63,1.63),P=0 95]、遠(yuǎn)期并發(fā)癥發(fā)生率[OR 0.46,95%CI(0.18,1.16),P=0.1]方面均無統(tǒng)計(jì)學(xué)差異.腹腔鏡手術(shù)亞組分析提示:經(jīng)腹腔腹膜外修補(bǔ)術(shù)組在術(shù)后復(fù)發(fā)率[OR1.24,95%CI(0.65,2.36),P=0 52]、圍手術(shù)期并發(fā)癥[OR 0.89,95%CI(0 65,1.22),P=0.46]和術(shù)后持續(xù)疼痛[OR 0.76,95%CI(0.鈣,1.19),P=0 22]方面與開放修補(bǔ)術(shù)比較,無統(tǒng)計(jì)學(xué)差異;全腹膜外補(bǔ)片植入術(shù)組在復(fù)發(fā)[OR1.07,95%CI(0.51,.24),P=0.70]和術(shù)后持續(xù)疼痛[OR 0.95,95%CI(0.55,1 65),P=0.86]方面與開放修補(bǔ)術(shù)比較無差異,但在圍手術(shù)期并發(fā)癥[OR0.5095%CI(0.34,0.73),P=0.0004]方面則差異有統(tǒng)計(jì)學(xué)意義.
結(jié)論 　目前的研究資料顯示,前路平片法與疝環(huán)充填式無張力修補(bǔ)術(shù)治療腹股溝疝的療效無明顯差別;腹腔鏡手術(shù)TEP術(shù)式較開放式疝修補(bǔ)術(shù)在圍手術(shù)期并發(fā)癥方面有明顯的優(yōu)勢(shì),而復(fù)發(fā)率和術(shù)后持續(xù)性疼痛方面還需要進(jìn)-步研究.

引用本文： 周建平,劉 祺. 成人腹股溝疝無張力修補(bǔ)術(shù)隨機(jī)對(duì)照試驗(yàn)的Meta分析. 中國循證醫(yī)學(xué)雜志, 2005, 05(4): 303-310. doi: 復(fù)制

1. 方仲雄,唐健雄,陳革,黃磊,周軼群,王巍,戴松林.疝環(huán)充填式與平片無張力疝修補(bǔ)術(shù)在治療老年腹股溝疝中的比較[J]老年醫(yī)學(xué)與保健,2001;7(2):75～76.
2. 龍延濱,邱健,楊德慶,王小強(qiáng),李國威.疝環(huán)充填式與平片式無張力疝修補(bǔ)術(shù)治療腹股溝疝的臨床比較研究[J]外科理論與實(shí)踐,2002;7(6):454～458.
3. 王堅(jiān),吳志勇.疝環(huán)充填式與平片無張力疝修補(bǔ)近期隨訪研究[J]外科理論與實(shí)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(bǔ)術(shù)185例臨床分析[J]中國冶金工業(yè)醫(yī)學(xué)雜志,2002;19(2):98～99.
5. 周建平,李鐵鋼,范丹鳳.Prolene網(wǎng)片在成人腹股溝疝前路修補(bǔ)中的應(yīng)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(wǎng)片前路修補(bǔ)經(jīng)驗(yàn)[J]外科理論與實(shí)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(bǔ)的術(shù)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. 1. 方仲雄,唐健雄,陳革,黃磊,周軼群,王巍,戴松林.疝環(huán)充填式與平片無張力疝修補(bǔ)術(shù)在治療老年腹股溝疝中的比較[J]老年醫(yī)學(xué)與保健,2001;7(2):75～76.
  2. 2. 龍延濱,邱健,楊德慶,王小強(qiáng),李國威.疝環(huán)充填式與平片式無張力疝修補(bǔ)術(shù)治療腹股溝疝的臨床比較研究[J]外科理論與實(shí)踐,2002;7(6):454～458.
  3. 3. 王堅(jiān),吳志勇.疝環(huán)充填式與平片無張力疝修補(bǔ)近期隨訪研究[J]外科理論與實(shí)踐,2002;7(6):448～450.
  4. 4. 李晉忠,孫立中,劉京山,趙期康兩種無張力疝修補(bǔ)術(shù)185例臨床分析[J]中國冶金工業(yè)醫(yī)學(xué)雜志,2002;19(2):98～99.
  5. 5. 周建平,李鐵鋼,范丹鳳.Prolene網(wǎng)片在成人腹股溝疝前路修補(bǔ)中的應(yīng)用[J].中國普通外科雜志,2002;11(8):499～500.
  6. 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(wǎng)片前路修補(bǔ)經(jīng)驗(yàn)[J]外科理論與實(shí)踐,2002;7(6):440～442.
  7. 7. 楊峰,莫立顯,石大洋,陳茂榮腹股溝疝無張力修補(bǔ)的術(shù)式選擇[J].腹部外科,2003;16(4):241 242.
  8. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 32. Lichtenstein IL,Am id PK, Shulman AG, Montllor MM. The tension-free hernioplasty[J]. Am J Surg, 1989; 157(2): 188-193.
  33. 33. Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992; 35(2): 209-212.
  34. 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. 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. 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. 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. 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. 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.