McIntosh A, Hutchinson A, Roberts A, Withers H
Section of Public Health, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
Fam Pract. 2000 Oct;17(5):442-7. doi: 10.1093/fampra/17.5.442.
National clinical guidelines on the surgical management of groin hernia have been published by the Royal College of Surgeons of England. There is also a need for guidance on the management of pre- and post-hernia repair patients in primary care, in areas such as diagnosis, referral and advice on recuperation.
The purpose of the present study was to determine best practice in primary care aspects of managing groin hernia in adults, by examination of the evidence base.
A systematic review of the available evidence was carried out, searching the major electronic databases: Medline, the Cochrane Library, Embase, Assia, Helmis, Cinahl and Psyclit. Key search terms were hern$, inguinal, femoral, groin, truss$, with searches limited to human adult subjects and the English language.
Robust research on groin hernia is concerned almost exclusively with the in-patient surgical management of patients undergoing primary elective hernia repair. The areas with which this review was concerned, principally diagnosis, referral and advice about return to work, are areas in which it is more difficult to conduct robustly designed studies. Perhaps because of this, the evidence base on the non-surgical aspects of management is of poor methodological quality, being based primarily on expert opinion, reviews of clinical practice and experience, surveys, descriptive case studies and clinical audits.
As the research in this area is generally of poor quality, strong conclusions are precluded, but it is possible to define best practice in some areas of care. In relation to diagnosis, GPs should distinguish correctly between a femoral and inguinal hernia because of the increased risks of strangulation and incarceration associated with the former. Due to clinical inaccuracy, the identification of whether a hernia is direct or indirect is not a good basis on which to base decision making regarding referral for elective repair. The risks associated with surgical repair are those of the normal range found for any procedure. Decisions about the fitness of patients for surgery in this instance are not procedure specific, and therefore the decisions about elective repair especially in older patients should be considered in terms of quality of life and patient choice rather than increased risks with surgical repair. Further research is required to address the gap in the evidence for the management of groin hernia within the primary care sector.
英国皇家外科医学院已发布关于腹股沟疝外科治疗的国家临床指南。在初级保健中，对于腹股沟疝修补术前和术后患者的管理，如诊断、转诊及康复建议等方面，也需要相关指导。
本研究旨在通过审视证据基础，确定成人腹股沟疝初级保健管理方面的最佳实践。
对现有证据进行系统综述，检索主要电子数据库：医学索引数据库（Medline）、考科蓝图书馆（Cochrane Library）、荷兰医学文摘数据库（Embase）、亚洲学术期刊集成数据库（Assia）、中东地区医学索引数据库（Helmis）、护理学与健康领域数据库（Cinahl）及心理学文摘数据库（Psyclit）。主要检索词为“疝”（hern$）、腹股沟、股部、腹股沟区、疝气带（truss$），检索限于成年人类受试者及英文文献。
关于腹股沟疝的有力研究几乎完全集中于接受初次择期疝修补术患者的住院手术管理。本综述关注的领域，主要是诊断、转诊及关于重返工作的建议，在这些领域开展设计严谨的研究较为困难。或许正因如此，管理的非手术方面的证据基础在方法学质量上较差，主要基于专家意见、临床实践综述与经验、调查、描述性病例研究及临床审计。
由于该领域研究质量普遍较差，难以得出有力结论，但在某些护理领域可界定最佳实践。关于诊断，全科医生应正确区分股疝和腹股沟疝，因为前者发生绞窄和嵌顿的风险增加。由于临床准确性问题，确定疝是直疝还是斜疝并非决定择期修补转诊的良好依据。手术修复相关风险处于任何手术的正常范围内。在此情况下，关于患者手术适宜性的决策并非特定于手术操作，因此，特别是对于老年患者，择期修复的决策应从生活质量和患者选择角度考虑，而非手术修复风险增加。需要进一步研究以填补初级保健部门腹股沟疝管理证据方面的空白。
