腹腔镜与开放式前腹壁疝修补术：使用 ACS-NSQIP 数据库的 30 天发病率和死亡率。

Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database.

机构信息

Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

出版信息

Ann Surg. 2011 Oct;254(4):641-52. doi: 10.1097/SLA.0b013e31823009e6.

DOI:10.1097/SLA.0b013e31823009e6

PMID:21881493

Abstract

OBJECTIVE

To compare short-term outcomes after laparoscopic and open abdominal wall hernia repair.

METHODS

Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2009), 71,054 patients who underwent an abdominal wall hernia repair were identified (17% laparoscopic, 83% open). Laparoscopic and open techniques were compared. Regression models and nonparametric 1:1 matching algorithms were used to minimize the influence of treatment selection bias. The association between surgical approach and risk-adjusted adverse event rates after abdominal wall hernia repair was determined. Subgroup analysis was performed between inpatient/outpatient surgery, strangulated/reducible, and initial/recurrent hernias as well as between umbilical, incisional and other ventral hernias.

RESULTS

Patients undergoing laparoscopic repair were less likely to experience an overall morbidity (6.0% vs. 3.8%; odds ratio [OR], 0.62; 95% confidence interval [CI], 0.56-0.68) or a serious morbidity (2.5% vs. 1.6%; OR, 0.61; 95% CI, 0.52-0.71) compared to open repair. Analysis using multivariate adjustment and patient matching showed similar findings. Mortality rates were the same. Laparoscopically repaired strangulated and recurrent hernias, had a significantly lower overall morbidity (4.7% vs. 8.1%, P < 0.0001 and 4.1% vs. 12.2%, P < 0.0001, respectively). Significantly lower overall morbidity was also noted for the laparoscopic approach when the hernias were categorized into umbilical (1.9% vs. 3.0%, P = 0.009), ventral (3.9% vs. 6.3%, P < 0.0001), and incisional (4.3% vs. 9.1%, P < 0.0001). No differences were noted between laparoscopic and open repairs in patients undergoing outpatient surgery, when the hernias were reducible.

CONCLUSION

Laparoscopic hernia repair is infrequently used and associated with lower 30-day morbidity, particularly when hernias are complicated.

摘要

目的

比较腹腔镜和开放式腹壁疝修补术的短期疗效。

方法

利用美国外科医师学会全国手术质量改进计划（ACS-NSQIP）数据库（2005-2009 年），共纳入 71054 例行腹壁疝修补术的患者（17%腹腔镜，83%开放式）。比较腹腔镜和开放式技术。采用回归模型和非参数 1:1 匹配算法，尽量减少治疗选择偏倚的影响。确定手术方式与腹壁疝修补术后风险调整不良事件发生率之间的关系。对门诊/住院手术、嵌顿/可复性疝，以及初次/复发性疝，脐疝、切口疝和其他腹疝进行亚组分析。

结果

与开放式修补术相比，腹腔镜修补术患者总体并发症发生率（6.0% vs. 3.8%；比值比[OR]，0.62；95%置信区间[CI]，0.56-0.68）和严重并发症发生率（2.5% vs. 1.6%；OR，0.61；95% CI，0.52-0.71）均较低。多变量调整和患者匹配分析也得出了类似的结果。死亡率相同。腹腔镜修补的嵌顿性和复发性疝总体并发症发生率显著较低（4.7% vs. 8.1%，P < 0.0001；4.1% vs. 12.2%，P < 0.0001）。当疝分为脐疝（1.9% vs. 3.0%，P = 0.009）、腹疝（3.9% vs. 6.3%，P < 0.0001）和切口疝（4.3% vs. 9.1%，P < 0.0001）时，腹腔镜方法的总体并发症发生率也显著较低。在门诊手术且疝可复性的患者中，腹腔镜与开放式修补术之间无差异。