比较开放与腹腔镜腹股沟疝修补术的随机临床试验的Meta分析

Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair.

作者信息

Memon M A, Cooper N J, Memon B, Memon M I, Abrams K R

机构信息

Department of Surgery, Nottingham City Hospital, Nottingham, UK.

出版信息

Br J Surg. 2003 Dec;90(12):1479-92. doi: 10.1002/bjs.4301.

DOI:10.1002/bjs.4301

PMID:14648725

Abstract

BACKGROUND

The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic (LIHR) and open (OIHR) inguinal hernia repair.

METHODS

A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials that compared OIHR and LIHR and were published in the English language between January 1990 and the end of October 2000. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed were operating time, time to discharge from hospital, return to normal activity and return to work, postoperative complications and recurrence rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences.

RESULTS

Twenty-nine trials were considered suitable for meta-analysis. Some 3017 hernias were repaired laparoscopically and 2972 hernias were repaired using an open method in 5588 patients. For four of the six outcomes the summary point estimates favoured LIHR over OIHR; there was a significant reduction of 38 per cent in the relative odds of postoperative complications (odds ratio 0.62 (95 per cent confidence interval (c.i.) 0.46 to 0.84); P = 0.002), 4.73 (95 per cent c.i. 3.51 to 5.96) days in time to return to normal activity (P < 0.001), 6.96 (95 per cent c.i. 5.34 to 8.58) days in time to return to work (P < 0.001) and 3.43 (95 per cent c.i. 0.35 to 6.50) h in time to discharge from hospital (P = 0.029). There was a significant increase of 15.20 (95 per cent c.i. 7.78 to 22.63) min in the mean operating time for LIHR (P < 0.001). The relative odds of short-term recurrence were increased by 50 per cent for LIHR compared with OIHR, although this result was not statistically significant (odds ratio 1.51 (95 per cent c.i. 0.81 to 2.79); P = 0.194).

CONCLUSION

LIHR was associated with earlier discharge from hospital, quicker return to normal activity and work, and significantly fewer postoperative complications than OIHR. However, the operating time was significantly longer and there was a trend towards an increase in the relative odds of recurrence after laparoscopic repair.

摘要

背景

目的是对随机对照证据进行荟萃分析，以确定腹腔镜腹股沟疝修补术（LIHR）和开放腹股沟疝修补术（OIHR）的相对优势。

方法

检索Medline、Embase、科学引文索引、现刊目次和PubMed数据库，找出1990年1月至2000年10月底期间发表的、比较OIHR和LIHR的所有英文随机临床试验。荟萃分析按照荟萃分析报告质量（QUOROM）声明进行。分析的六个结果变量为手术时间、出院时间、恢复正常活动和恢复工作的时间、术后并发症及复发率。采用比值比和加权均数差值进行随机效应荟萃分析。

结果

29项试验被认为适合进行荟萃分析。5588例患者中，约3017例疝采用腹腔镜修补，2972例疝采用开放手术修补。六个结果中的四个，汇总点估计显示LIHR优于OIHR；术后并发症的相对比值显著降低38%（比值比0.62（95%可信区间（c.i.）0.46至0.84）；P = 0.002），恢复正常活动的时间缩短4.73天（95% c.i. 3.51至5.96）（P < 0.001），恢复工作的时间缩短6.96天（95% c.i. 5.34至8.58）（P < 0.001），出院时间缩短3.43小时（95% c.i. 0.35至6.50）（P = 0.029）。LIHR的平均手术时间显著增加15.20分钟（95% c.i. 7.78至22.63）（P < 0.001）。与OIHR相比，LIHR短期复发的相对比值增加了50%，尽管这一结果无统计学意义（比值比1.51（95% c.i. 0.81至2.79）；P = 0.194）。