轻量型网片和重量型网片应用于Lichtenstein腹股沟疝修补术长期疗效的Meta分析

目的评价Lichtenstein腹股沟疝修补术中轻量型网片与重量型网片的远期临床疗效及安全性。方法计算机检索Pub Med、EMBASE、The Cochrane图书馆、Web of Science、中国生物医学文献数据库、中国期刊全文数据库、万方数字化期刊群和维普中文科技期刊数据库,检索时间均从建库至2013年11月,同时追溯纳入文献的参考文献。由两名评价者按照纳入与排除标准以及Cochrane协作网推荐的方法独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Rev Man 5.2.5软件进行Meta分析。结果共纳入15个随机对照试验,包含3 390例患者。Meta分析结果显示：与重量型网片相比,轻量型网片可减轻术后近期（≤12个月）慢性疼痛[6个月：相对危险度0.67,95%可信区间（0.53,0.83）,P=0.000 3;12个月：相对危险度0.79,95%可信区间（0.64,0.98）,P=0.03]和术后异物感[相对危险度0.69,95%可信区间（0.56,0.85）,P=0.000 5];而在术后远期（〉12个月）疼痛[相对危险度0.93,95%可信区间（0.72,1.19）,P=0.56]、复发[相对危险度1.21,95%可信区间（0.77,1.90）,P=0.41]和睾丸萎缩[相对危险度1.90,95%可信区间（0.58,6.28）,P=0.29]的发生率方面差异无统计学意义。结论与重量型网片相比,轻量型网片可降低术后短期慢性疼痛并减少异物感,且未增加复发。在腹股沟疝修补术中,可以将轻量型网片作为首选。

Long-Term Efficacy of Lightweight Meshes Versus Heavyweight Meshes in Lichtenstein Repair for Inguinal Hernias: A Meta-Analysis

Objective The aim of this study was to assess the long-term clinical efficacy and safety of lightweight meshes and heavyweight meshes in the Lichtenstein repair for inguinal hernias. Methods Such databases as Pub Med,EMBASE, Web of Science, The Cochrane Library, CBM, CNKI, Wan Fang Data and VIP were electronically searched for relevant studies from inception to November, 2013. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using Rev Man 5.2.5 software. Results 15 RCTs involving 3 390 patients were included. The results of meta-analysis showed that ： Compared with heavyweight meshes, lightweight meshes was associated with a lesser incidence of chronic pain during the short-term（≤12 months） postoperative period（6 months：RR=0.67, 95%CI 0.53 to 0.83, P =0.000 3; 12 months： RR=0.79, 95%CI 0.64 to 0.98, P =0.03）, sensation of a foreign body（RR=0.69, 95%CI 0.56 to 0.85, P=0.000 5）. However, there was no statistically significant difference in the incidence of chronic pain during the long-term（12 months） postoperative period（RR=0.93, 95%CI 0.72 to1.19, P=0.56）, recurrence（RR=1.21, 95%CI 0.77 to 1.90, P=0.41） and testicular atrophy（RR=1.90, 95%CI 0.58 to 6.28, P=0.29）. Conclusion Current evidence suggests that the use of lightweight meshes is associated with less short-term postoperative pain and less sensation of a foreign body, without increasing the incidence of recurrence. The lightweight mesh can be used as the preferred for the hernioplasty procedure.