【摘要】：目的:比較開放式腹股溝疝無張力修補術(shù)中,輕量型補片和(中)重量型補片的療效和術(shù)后舒適度(如慢性疼痛、復(fù)發(fā)率、邊緣牽扯感、不適感的發(fā)生率)。方法:回顧性研究2011年1月至2014年1月間在我科行腹股溝疝無張力修補術(shù)的患者共145例(152側(cè)),隨訪率91.19%。研究分為輕量型補片組59例(60側(cè))和中量型補片組86例(92側(cè))。于術(shù)后3月、6月及12月行門診和電話隨訪,對比分析兩組患者手術(shù)前后的慢性疼痛、復(fù)發(fā)率、邊緣牽扯感、舒適度等的發(fā)生率。進而,使用Meta分析,系統(tǒng)比較輕量型補片和重量型補片研究中的結(jié)果,采用的結(jié)局指標有,術(shù)后6個月,術(shù)后12個月時慢性疼痛,腹股溝區(qū)不適,異物感,以及總的復(fù)發(fā)率。結(jié)果:輕量型補片組和中量型補片組術(shù)后疝復(fù)發(fā)率分別為1.67%和1.09%(P=0.762)。在術(shù)后3月和6月,二組病例的疼痛發(fā)生率、疼痛程度、腹股溝區(qū)不適發(fā)生率、異物感發(fā)生率及邊緣牽扯感發(fā)生率均無顯著差異。術(shù)后1年時,輕量型補片組和中量型補片組的疼痛發(fā)生率(8.51%vs 12.50%)、異物感發(fā)生率(4.26%vs 12.50%)、VAS疼痛評分均值[(0.19±0.68)vs(0.21±0.71)]及邊緣牽扯感(6.38%vs5.35%)均無顯著性差異。但在術(shù)后腹股溝區(qū)不適發(fā)生率上,輕量型補片組為17.02%,顯著優(yōu)于中量型補片組的37.50%(P=0.021)。進而,行文獻資料的分析和歸納。檢索2000年-2014年的Pubmed,Ebsco,Embase,Web of Science數(shù)據(jù)庫內(nèi)相關(guān)文獻。總共有10篇包含2322名患者的RCT文獻適合于我們的Meta分析研究。在固定效應(yīng)模型中,輕量型補片組和(中)重量型補片組復(fù)發(fā)率沒有統(tǒng)計學(xué)差異[OR=1.34,95%CI(0.74~2.43),P=0.33]。根據(jù)孔徑大小的差異大于或小于1mm,分為Group A和Group B,進一步的分層分析顯示,在孔徑大小差異大的亞組中,輕量型補片相較于重量型補片,在12個月慢性疼痛發(fā)生率上較低[OR=0.65,95%CI(0.47~0.90),P=0.01]。結(jié)論:輕量型補片在腹股溝疝無張力修補術(shù)的應(yīng)用是安全有效,并且不增加術(shù)后復(fù)發(fā)率。1年期的隨訪結(jié)果顯示輕量型補片組的腹股溝區(qū)不適發(fā)生率顯著低于中量型補片組。相較于補片重量而言,網(wǎng)孔大小對開放式腹股溝疝修補術(shù)后慢性疼痛、腹股溝區(qū)不適、異物感方面或更具重要影響。
[Abstract]:Objective: to compare the efficacy and comfort of open tension-free inguinal hernia repair with light and (medium) weight patch (such as chronic pain, recurrence rate, marginal involvement and discomfort). Methods: a retrospective study of 145 cases (152 sides) of inguinal hernia tension-free repair from January 2011 to January 2014 was performed. The follow-up rate was 91.19. 59 cases (60 sides) and 86 cases (92 sides) were divided into two groups: light patch group (n = 59) and medium dose group (n = 86). After 3 months, 6 months and 12 months after operation, outpatient and telephone follow-up were performed to compare the incidence of chronic pain, recurrence rate, marginal involvement and comfort between the two groups before and after operation. Then, Meta-analysis was used to systematically compare the results of lightweight patch and weight patch. The outcome indexes were chronic pain, groin discomfort, foreign body sensation and total recurrence rate at 6 months after operation and 12 months after operation. Results: the recurrence rate of hernia was 1.67% and 1.09% in the light and medium dose group respectively (P0. 762). There was no significant difference in the incidence of pain, the degree of pain, the incidence of inguinal discomfort, the incidence of foreign body sensation and the incidence of marginal involvement between the two groups at 3 and 6 months after operation. There was no significant difference in the incidence of pain (8.51%vs 12.50%), foreign body sensation (4.26%vs 12.50%) and marginal involvement (6.38 vs 5.35%) in the light and moderate dose groups at 1 year after operation. The mean score of pain score was (0.19 鹵0.68) vs (0.21 鹵0.71) and the marginal involvement was (6.38 vs 5.35%). However, the incidence of postoperative discomfort in inguinal area was 17.022 in the light dose patch group, which was significantly higher than that in the medium dose patch group (37. 50%) (P0. 021). Then, the analysis and induction of the literature. To search the relevant literature in the Pubmedus Ebscobase Web of Science database from 2000 to 2014. A total of 10 RCT articles covering 2322 patients were suitable for our meta-analysis study. In the fixed effect model, there was no significant difference in the recurrence rate between the light dose patch group and the (middle) weight supplement group [ORA 1.34N 95 CI (0.742.43) Pao 0.33]. Group A and Group B were divided into Group A and Group B according to the difference of aperture size, and further stratification analysis showed that the incidence of chronic pain was lower in the subgroup with large difference in aperture size than that in the weight patch [OR0.65% 95% CI (0.470.90) P0.01]. Conclusion: the application of lightweight patch in inguinal hernia tension-free repair is safe and effective, and does not increase the recurrence rate. The results of 1-year follow-up showed that the incidence of inguinal discomfort in the light patch group was significantly lower than that in the moderate dose patch group. Compared with the weight of the patch, the size of the mesh may play a more important role in chronic pain, groin discomfort and foreign body sensation after open inguinal hernioplasty.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.21

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