儿童腹股沟疝腹腔镜与开放手术效果与安全性的Meta分析

目的比较腹腔镜与开放疝囊高位结扎术治疗儿童腹股沟疝的安全性和效果。 方法制定严格的纳入标准与排除标准，检索中国生物医学文献检索分析系统光盘数据库、中国期刊全文数据库、万方数据库、PubMed、EMbase等数据库，收集1987至2018年腹腔镜疝囊高位结扎术（LH）和传统疝囊高位结扎术（OH）治疗儿童腹股沟疝的随机对照试验，按照Cochrane协作网推荐的方法对纳入研究进行系统分析。 结果11篇随机对照试验（1508例患者）纳入分析，LH组757例，OH组751例。LH组与OH组比较睾丸萎缩发生率[OR=0.15，95% CI（0.03~0.84），P=0.03]、术后总并发症发生率[OR=0.15，95% CI（0.08~0.26），P<0.000 01]、复发率[RR=0.33，95% CI（0.18~0.62），P=0.000 5]均较低。与OH组比较，双侧疝亚组，LH组的手术时间较短[MD=－8.82，95% CI（－11.80~－5.83），P<0.000 01]，而对于单侧疝亚组，2组的手术时间无明显差异[MD=－2.71，95% CI（－7.96~2.54），P=0.31]。恢复正常活动的时间[MD=－0.06，95% CI（－0.66~0.53），P=0.84]和止痛药物的使用剂量[MD=－0.84，95% CI（－0.36~1.93），P=0.55]，组间均无明显差异。 结论Meta分析显示，LH较OH有明显的优势，特别是减少术后并发症及疝复发方面，但仍需要高质量的随机对照试验进一步支持。

Comparison of efficacy and safety of laparoscopic and open inguinal herniorrhaphy in children: a Meta-analysis

ObjectiveTo analyze the safety and efficacy of laparoscopic herniorrhaphy (LH) compared with open high ligation of the hernia sac herniorrhaphy (OH) in children. MethodsStrict inclusion and exclusion criteria were set up. Databases including CBMdisc, CNKI, Wanfang, PubMed and EMbase were searched. All the randomized controlled trials (RCT) on LH and OH for inguinal hernia from 1987 to 2018 were collected. Systematical analysis was performed according to the recommendation by the Cochrane handbook. ResultsEleven RCTs including 1508 patients were included in the analysis. They were divided into LH group (n=757) and OH group (n=751). Rate of testicular atrophy [OR=0.15, 95% CI (0.03, 0.84), P=0.03], total complications [OR=0.15, 95% CI (0.08, 0.26), P<0.000 01] and recurrence [RR=0.33, 95% CI (0.18, 0.62), P=0.000 5] were significantly lower in LH group compared to OH group. Compared with OH group, the operative time was significantly shorter in LH group for bilateral hernia repairs [MD=-8.82, 95% CI (-11.80, -5.83), P<0.000 01]. There was no difference between the two groups regarding operative time for unilateral hernia repairs [MD=-2.71, 95% CI (-7.96, 2.54), P=0.31]. There were no significant differences in the time before full activity [MD=-0.06, 95% CI (-0.66, 0.53), P=0.84] and analgetic dosage [MD=-0.84, 95% CI (-0.36 1.93), P=0.55] between the two groups. ConclusionIn this meta-analysis, LH showed obvious advantages over OH, especially in reducing postoperative complications and recurrence. However, more high quality RCTs were needed to further supported it.