单孔与常规全腹膜外疝修补术治疗腹股沟疝的临床效果比较meta分析  

Comparison of therapeutic effect between single-port and conventional laparoscopic totally extraperitoneal inguinal hernia repair:a meta-analysis

作　　者：杨诗语 于志远 柳博文 张旭[1] 孙岩[1] YANG Shiyu;YU Zhiyuan;LIU Bowen;ZHANG Xu;SUN Yan(Department of General Surgery,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,P.R.China)

机构地区：[1]哈尔滨医科大学附属第二医院普外七科,哈尔滨150081

出　　处：《中国普外基础与临床杂志》2022年第5期648-657,共10页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的系统评价单孔腹腔镜全腹膜外(single-port laparoscopic totally extraperitoneal,SPTEP)与常规腹腔镜全腹膜外(conventional laparoscopic totally extraperitoneal,CTEP)疝修补术治疗腹股沟疝的临床效果。方法计算机检索PubMed、Cochrane Library、Embase、万方数据、维普期刊、CNKI数据库,搜集SPTEP与CTEP治疗腹股沟疝效果比较的随机和非随机对照试验研究,检索时限为2010年1月至2019年11月。由2名研究者独立筛选文献、提取资料并评价纳入文献的质量,然后采用RevMan5.3软件对最终纳入的文献数据整理后进行meta分析。结果共纳入17篇文献、2072例病例,其中SPTEP组1106例、CTEP组966例。meta分析结果显示,与CTEP组相比,SPTEP组术后住院时间[SMD=–0.12,95%CI(–0.22,–0.02),P=0.01]和术后恢复正常活动时间[SMD=–1.17,95%CI(–2.10,–0.23),P=0.01]更短、手术切口满意评分更高[SMD=0.92,95%CI(0.31,1.53),P<0.01],但无论是单侧腹股沟疝[MD=4.08,95%CI(0.34,7.83),P=0.03]还是双侧腹股沟疝[MD=5.53,95%CI(0.39,10.68),P=0.04]手术时间均较CTEP组长,2组患者术后(24 h和7 d)疼痛评分、术后并发症发生率、对切口满意率及住院费用方面比较差异均无统计学意义(P>0.05)。结论从分析结果看,SPTEP在术后住院时间、恢复正常活动时间和切口美观性方面有一定优势,但手术时间较长,提示SPTEP虽发展数年,但仍难以替代CTEP。Objective To systematically evaluate the effect of single-port totally extraperitoneal(SPTEP)and conventional totally extraperitoneal(CTEP)inguinal hernia repair in treatment of inguinal hernia.Methods PubMed,Cochrane Library,Embase,WanFang Data,VIP,and CNKI databases were electronically searched and the randomized controlled trial(RCT)and non-RCT studies on the efficacy and safety of SPTEP versus CTEP for patients with inguinal hernia from January 2010 to November 2019 were collected.Two reviewers independently screened literatures,extracted data,and assessed risk of bias of included studies,then the meta-analysis was performed by using RevMan5.3 software.Results A total of 17 clinical studies were included in the analysis,with 1106 cases in the SPTEP group and 966 cases in the CTEP group.The results of meta-analysis showed that:the hospital stay[SMD=–0.12,95%CI(–0.22,–0.02),P=0.01]and the time to resume normal activity[SMD=–1.17,95%CI(–2.10,–0.23),P=0.01]were shorter,the satisfaction score of incision scars[SMD=0.92,95%CI(0.31,1.53),P<0.01]was higher in the SPTEP group as compared with the CTEP group.However,the operative time of SPTEP group was longer than that of the CTEP group both for unilateral inguinal hernia[MD=4.08,95%CI(0.34,7.83),P=0.03]and bilateral inguinal hernia[MD=5.53,95%CI(0.39,10.68),P=0.04].There were no statistical differences in the postoperative pain score(24 h and 7 d),incidence of postoperative complications,the rate of patients satisfied with the incision,and hospitalization costs between the two groups(P>0.05).Conclusions From the results of this meta-analysis,SPTEP has some certain advantages in shortening hospital stay and returning to normal activity time,and improving incision satisfaction.However,compared with CTEP,mean operative time of SPTEP is longer.Although SPTEP has developed for several years,it is difficult to replace CTEP.

关 键 词：腹股沟疝 单孔腹腔镜 全腹膜外 手术效果 并发症 META分析 

分 类 号：R656.21[医药卫生—外科学]