腹腔镜全腹膜外疝修补术中网片固定与不固定的系统评价

目的比较网片固定与不固定在腹腔镜全腹膜外疝修补术中的临床疗效。方法检索PubMed、Cochrane Libraly、EMBASE、SCI、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、数字化期刊全文数据库收录的公开发表与研究目的相关的临床随机和半随机对照的研究文献。提取数据，对满足条件的数据进行合并分析，Meta分析软件用RevMan5．0。评价指标包括：手术时间、术后住院时间、恢复正常活动时间、血清肿、疼痛和住院费用。结果6个随机对照试验（562例患者）纳入分析，网片不固定组284例，网片固定组278例。Meta分析显示：网片不固定组在手术时间加权均数差-3．07，95％可信区间（-6．94，0．80）]，恢复正常活动时间加权均数差-0．13，95％可信区间（-0．45，0．19）]，血清肿比值比0．86，95％可信区间（0．32，2．35）]，疼痛评分加权均数差-0．16，95％可信区间（-0．38，0．06）]和慢性疼痛比值比1．62，95％可信区间（0．41，6．39）]方面和网片固定组相比差异无统计学意义，而在术后住院时间标准化均数差值-0．55，95％可信区间（-0．88，-0．22）]和住院费用标准化均数差值-1．41，95％可信区间（-2．54，-0．28）1方面优于网片固定组。结论目前证据显示，网片不固定的全腹膜外疝修补术降低了手术费用，减少了术后住院时间。在手术时间、恢复正常活动时间、血清肿和疼痛等方面与网片固定相似。

Laparoscopic Totally Extraperitoneal Hernia Repair with or without Mesh Fixation: A Systematic Review

Objective To compare the effectiveness in total extraperitoneal inguinal hernioplasty （TEP） with or without mesh fixation using staples. Methods PubMed, Cochrane Library, EMBASE, SCI, China Journal Full-text Database, Chinese Biomedical Database, Chinese Scientific Journals Full-text Database, and WanFang Database Online were used to search the published clinical randomized controlled trials and semi-randomized controlled trials about TEP with or without mesh fixation by staples. All the related data that matched our standards were abstracted for meta- analysis by RevMan 5.0. The evaluation criteria included operative time, hospital length of stay, return to activity, seroma, pain and hospital cost. Results 562 patients of 6 RCTs were included. Compared with TEP with mesh fixation, TEP without mesh fixation had no significant difference in operative time WMD=-3.07, 95%CI （-6.94, 0.80）1, return to activity WMD=-0.13, 95%CI （-0.45, 0.19）], seroma OR=0.86, 95%CI （0.32, 2.35）],pain score WMD=-0.16, 95%CI（-0.38, 0.06）] and chronic pain OR=1.62, 95%CI （0.41, 6.39）], but hospital length of stay SMD=-0.55,95%CI （-0.88, -0.22） ] and hospital cost SMD=-1.41, 95%CI （-2.54, -0.28） ] was significantly lower. Conclusion Current evidence suggests that there was no significant difference in total extraperitoneal inguinal hernloplasty （TEP） with or without mesh fixation using staples. However, TEP without mesh fixation was associated with less hospital length of stay and hospital cost. Further high-quality, long follow-up period RCTs should be carried out to provide more reliable evidence.