【摘要】：目的:采用Meta分析評(píng)估腹腔鏡與開(kāi)放無(wú)張力疝修補(bǔ)術(shù)治療成人復(fù)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(kù)進(jìn)行相關(guān)文獻(xiàn)的全面檢索:PubMed、EMbase、Cochrane Library、Web of Science、生物醫(yī)學(xué)、知網(wǎng)、維普和萬(wàn)方數(shù)據(jù)庫(kù),同時(shí)輔以其他檢索方法,檢索時(shí)間范圍均限定于1990年1月至2014年5月,檢索語(yǔ)種為中文和英文兩種。收集所有對(duì)比兩種不同手術(shù)方式治療成人復(fù)發(fā)疝的療效及安全性的隨機(jī)對(duì)照試驗(yàn)(RCT)。由兩名評(píng)價(jià)員按照納入與排除標(biāo)準(zhǔn)獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取并交叉核對(duì),使用Cochrane協(xié)作網(wǎng)推薦軟件Rev Man 5.3版本對(duì)數(shù)據(jù)實(shí)施統(tǒng)計(jì)分析。結(jié)果:最終納入11篇RCT,共1039例病人。Meta分析結(jié)果顯示:兩種不同手術(shù)方法在腹股溝復(fù)發(fā)疝術(shù)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(shù)后恢復(fù)日常活動(dòng)時(shí)間[國(guó)外:MD=-4.54,95%CI(-5.59,-3.49),P0.00001,國(guó)內(nèi):MD=-2.24,95%CI(-2.55,-1.93),P0.00001]和手術(shù)時(shí)間[MD=4.57,95%CI(2.83,6.30),P0.00001]方面的差異有統(tǒng)計(jì)學(xué)意義,而在術(shù)后再?gòu)?fù)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(shù)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(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:與開(kāi)放無(wú)張力手術(shù)相比,腹腔鏡手術(shù)不僅可以降低腹股溝復(fù)發(fā)疝的術(shù)后慢性疼痛發(fā)生率與切口感染率,還可以縮短其術(shù)后恢復(fù)日常活動(dòng)時(shí)間,但腹腔鏡手術(shù)的手術(shù)時(shí)間較長(zhǎng)。臨床上可根據(jù)病人的具體情況及要求并結(jié)合臨床醫(yī)生的經(jīng)驗(yàn)選擇最優(yōu)的再手術(shù)方法以取得良好的手術(shù)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(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R656.21

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉保成;腹膜前修補(bǔ)復(fù)發(fā)性腹股溝疝16例[J];中國(guó)中西醫(yī)結(jié)合外科雜志;2000年06期

2 潘琦,陳福春,林加寶;疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)治療復(fù)發(fā)性腹股溝疝的臨床分析[J];浙江實(shí)用醫(yī)學(xué);2000年06期

3 王堅(jiān),鮑山林,徐少明;復(fù)發(fā)性腹股溝疝原因探討和治療[J];浙江醫(yī)學(xué);2000年10期

4 克力木·阿不都熱依木,王宗伯,韓振魁,凱塞爾,羅蘇明;疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)治療老年復(fù)發(fā)性腹股溝疝46例[J];新疆醫(yī)科大學(xué)學(xué)報(bào);2001年03期

5 何博平,郭娟;復(fù)發(fā)性腹股溝疝手術(shù)治療28例分析[J];浙江臨床醫(yī)學(xué);2003年01期

6 房俊平,宋吉宴,趙娜娜,刁其先;疝環(huán)填充式無(wú)張力疝修補(bǔ)術(shù)在復(fù)發(fā)性腹股溝疝中的應(yīng)用[J];中國(guó)現(xiàn)代普通外科進(jìn)展;2003年02期

7 克力木,賽福丁,王宗伯,凱賽爾;疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)治療復(fù)發(fā)性腹股溝疝的探討[J];外科理論與實(shí)踐;2003年02期

8 牟潔;腹膜前修補(bǔ)術(shù)治療復(fù)發(fā)性腹股溝疝21例[J];現(xiàn)代診斷與治療;2004年02期

9 楊波,蒲永東,林剛,何建苗,董立國(guó),劉衛(wèi)平;疝環(huán)充填式無(wú)張力疝修補(bǔ)術(shù)治療復(fù)發(fā)性腹股溝疝的臨床分析[J];腹部外科;2004年04期

10 李偉漢;老年復(fù)發(fā)性腹股溝疝的修復(fù)[J];中國(guó)修復(fù)重建外科雜志;2005年05期

相關(guān)會(huì)議論文 前2條

1 高國(guó)棟;王平;楊聰;王瑋;董兵;趙凱;楊俊;蘇燕燕;孔穎;;腹膜前修補(bǔ)在復(fù)發(fā)性腹股溝疝的應(yīng)用[A];2008年浙江省外科學(xué)術(shù)年會(huì)論文匯編[C];2008年

2 劉衛(wèi)懷;張建輝;李吉;張鵬斌;;無(wú)張力修補(bǔ)術(shù)后復(fù)發(fā)性腹股溝疝的5例再手術(shù)體會(huì)[A];2012年浙江省外科學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

相關(guān)碩士學(xué)位論文 前1條

1 趙健;腹腔鏡與開(kāi)放式無(wú)張力疝修補(bǔ)術(shù)治療成人復(fù)發(fā)性腹股溝疝療效的Meta分析[D];蘭州大學(xué);2016年

，

本文編號(hào)：2125982