Danish Ramazzini Centre, Department of Occupational Medicine, Herning Regional Hospital, Herning, Denmark.
Scand J Work Environ Health. 2013 Jan;39(1):5-26. doi: 10.5271/sjweh.3305. Epub 2012 May 29.
The aim of this review was to evaluate the epidemiologic evidence for (i) a causal effect of occupational mechanical exposures on incidence of inguinal hernia, and (ii) a prognostic effect of such exposures on hernia recurrence and persistent pain after inguinal hernia repair.
We performed a literature search in Medline, Embase, and Web of Science up to 3 November 2011. Central information was extracted from included studies, and strengths and limitations were discussed.
All 23 included studies focused on effects of (work) activities that hardly reflected specific occupational risk factors. Eight studies provided information on risk by occupation or occupational activities. Increased risk was reported in six studies, but inflationary bias was likely. The negative findings in two studies might well be explained by bias towards the null due to crude exposure and/or outcome assessment. Three studies on single strenuous events primarily reflected patients` beliefs regarding risk factors. Information on prognosis with respect to recurrence was found in seven studies. The studies used crude exposure assessment, and two were also underpowered. Four suggested an increased risk. Six studies on prognosis with respect to persistent pain (one of which also concerned recurrence) were practically non-informative for the purpose of this review.
There is insufficient epidemiologic evidence to draw meaningful conclusions about (i) the existence of causal associations between specific occupational mechanical exposures and the development of inguinal hernia, and (ii) the influence of these exposures on prognosis after inguinal hernia repair with respect to hernia recurrence and persistent pain.
本综述旨在评估（i）职业机械性暴露与腹股沟疝发病之间存在因果关系的流行病学证据，以及（ii）此类暴露对腹股沟疝修补术后疝复发和持续性疼痛的预后影响。
我们检索了 Medline、Embase 和 Web of Science 数据库，检索截至 2011 年 11 月 3 日。从纳入的研究中提取中心信息，并讨论其优缺点。
所有 23 项纳入的研究均集中于（工作）活动对疝的影响，这些活动很难反映特定的职业危险因素。8 项研究提供了职业或职业活动相关的风险信息。有 6 项研究报告了风险增加，但可能存在膨胀性偏倚。另外两项研究的阴性结果可能由于对暴露和/或结局评估的粗疏而很好地解释了对无效假设的偏倚。三项关于单一剧烈事件的研究主要反映了患者对危险因素的看法。有 7 项研究报道了与复发相关的预后信息。这些研究使用了粗略的暴露评估，且其中两项研究的效能不足。四项研究提示风险增加。6 项关于持续性疼痛（其中一项也涉及复发）的预后研究对于本综述的目的来说实际上没有提供信息。
目前的流行病学证据尚不足以得出关于（i）特定职业机械性暴露与腹股沟疝发生之间是否存在因果关系，以及（ii）这些暴露对腹股沟疝修补术后疝复发和持续性疼痛的预后影响的有意义的结论。
