腹腔镜完全腹膜外间隙与开放式无张力疝修补术治疗成人腹股沟疝临床疗效的Meta分析

目的：探讨腹腔镜完全腹膜外间隙疝修补术（TEP）与开放式无张力疝修补术治疗成人腹股沟疝的临床疗效。方法：检索PubMed、EMbase、万方、中国生物医学文献（CBM）、中国期刊全文数据库（CNKI）等数据库，搜索1990年1月至2013年12月间国内外公开发表的与研究目的相关的临床随机对照研究，观察两种手术方法的术后并发症、复发率、术后慢性疼痛、手术时间、恢复正常工作时间等指标，并进行统计学分析。结果：最终纳入文献共30篇，TEP组3173例，开放组3821例。Meta分析结果显示：TEP与开放术式相比，手术时间明显延长SMD=0．52，95％CI为0．14～0．90，P=0．007，恢复正常工作时间缩短SMD=-1．44，95％C，为-1．96～-0．92，P〈0．00001，复发率无差异OR=0．92，95％CI为0．61～1．39，P=0．71，并发症发生率无差异OR=1．14，95％CI为0．88～1．48，P=0．32，但术后慢性疼痛方面更有优势OR=0．47，95％a为0．25～0．88，P=0．02。结论：TEP在减轻慢性疼痛及缩短恢复工作时间等方面较开放式无张力疝修补术有明显优势，但TEP手术时间较长；两者在远期复发率及术后并发症发生率方面无明显差异。

Total extraperitoneal herniorrhaphy compared with open repair methods of inguinal hernia in adults： a Meta-analysis of outcomes of randomized controlled trials

Objective ： To explore the clinical （TEP） and open tension-free hernia repairs in CBM,CNKI and Wanfang We collected published were used to search for randomized controlled effects between total extraperitoneal laparoscopic herniorrhaphy adults. Methods： The electronic databases PubMed, EMbase, articles from January 1990 to December 2013 in any language. trials about the research. The evaluation criteria included postoperative complications, chronic pain, recurrence rate, operation time and time to return to normal work. The data was analyzed using the statistic software Review Manager 5.2. Results： Total 30 trials involving 6 994 participants were included in this Meta-analysis. A significant longer operation time was observed in TEP group compared with open repair group SMD = 0. 52,95% CI O. 14 - 0.90, P = 0. 007 ]. Compared with open repair method, time to return to normal work was shortened in TEP method SMD = - 1.44,95% CI - 1.96 - - 0. 92, P 〈0. 000 01 ]. There was no significant difference in recurrence rate OR =0. 92,95% CI O. 61 - 1.39 ,P =0.71 ] and postoperative complications OR = 1.14,95% CI O. 88 - 1.48, P = 0.32 ] between the two groups, while TEP had obvious advantages in chronic pain OR = 0.47,95% CI O. 25 -0. 88, P = 0.02 ]. Conclusion： TEP is superior to open repair in reducing chronic pain and speeding the recovery, but the operation time of TEP is lonnger; there is no significant difference in recurrence rate and postoperative complications between the two methods.