Chung R S, Rowland D Y
Department of Surgery, Meridia Huron Hospital, 13951 Terrace Road, Cleveland Clinic Health Systems, East Cleveland, OH 44112, USA.
Surg Endosc. 1999 Jul;13(7):689-94. doi: 10.1007/s004649901074.
Despite randomized controlled trials, the merits of laparoscopic hernia repair remain poorly defined. A meta-analysis may provide a timely overview.
An electronic MEDLINE search, supplemented by a manual search, yielded 14 randomized controlled trials with usable statistical data, involving 2,471 patients. The trials were grouped for separate meta-analyses according to the control operation, either a tension-free or sutured repair, used for comparison. The effect sizes for operating time, postoperative pain, return to normal activity, and early recurrence were calculated, using a random-effects model when the effect sizes were heterogeneous and without subcategories.
In all meta-analyses, the laparoscopic operation was significantly longer. When compared with tension-free repairs, the laparoscopic operation showed no advantage in terms of postoperative pain, but resulted in a shorter recovery (marginal significance). As compared with sutured repair, both postoperative pain and recovery were in favor of the laparoscopic operation. When all 14 trials were analyzed together, laparoscopic repairs still had moderately reduced postoperative pain and recovery time.
Laparoscopic hernia repair has a modest advantage over conventional repairs. This advantage is more apparent when laparoscopic repairs are compared with sutured repairs rather than tension-free repairs.
尽管有随机对照试验，但腹腔镜疝修补术的优点仍未明确界定。一项荟萃分析可能会及时给出概述。
通过电子检索MEDLINE并辅以手工检索，得到14项具有可用统计数据的随机对照试验，涉及2471例患者。根据用于比较的对照手术（无张力修补或缝合修补）将试验分组进行单独的荟萃分析。计算手术时间、术后疼痛、恢复正常活动和早期复发的效应量，当效应量存在异质性且无亚分类时使用随机效应模型。
在所有荟萃分析中，腹腔镜手术时间明显更长。与无张力修补相比，腹腔镜手术在术后疼痛方面无优势，但恢复时间较短（具有边际显著性）。与缝合修补相比，术后疼痛和恢复情况均有利于腹腔镜手术。当对所有14项试验进行综合分析时，腹腔镜修补术仍能适度减轻术后疼痛并缩短恢复时间。
腹腔镜疝修补术比传统修补术有适度优势。当腹腔镜修补术与缝合修补术而非无张力修补术进行比较时，这种优势更为明显。
