全腹膜外修补术与李金斯坦修补术：哪种技术更适合男性原发性单侧腹股沟疝的修补？
TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men?
作者信息
Köckerling F, Stechemesser B, Hukauf M, Kuthe A, Schug-Pass C
机构信息
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
Hernia Center Cologne, PAN - Hospital, Zeppelinstrasse 1, 50667, Cologne, Germany.
出版信息
Surg Endosc. 2016 Aug;30(8):3304-13. doi: 10.1007/s00464-015-4603-1. Epub 2015 Oct 21.
INTRODUCTION
In the update of the guidelines of the European Hernia Society, open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary inguinal hernias in men despite the fact that a meta-analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation. The Guidelines Group had taken that decision because one surgeon in one of the randomized controlled trials included in the meta-analysis had had a very high recurrence rate. Therefore, this study based on registry data now compares the outcome of TEP versus Lichtenstein repair.
PATIENTS AND METHODS
The analysis of the Herniamed Registry compares the prospective data collected for male patients undergoing primary unilateral inguinal hernia repair using either TEP or open Lichtenstein repair. Inclusion criteria were minimum age of 16 years, male patient, primary unilateral inguinal hernia, elective operation, and availability of data on 1-year follow-up. In total, 17,388 patients were enrolled between September 1, 2009, and August 31, 2013. Of these patients, 10,555 (60.70 %) had a Lichtenstein repair and 6833 (39.30 %) a TEP repair.
RESULTS
On multivariable analysis, the surgical technique was not found to have had any significant effect on the recurrence rate (p = 0.146) or on the chronic pain rate (p = 0.560). Nor did the complication-related reoperation rates differ significantly between the two techniques (p = 0.084). But TEP was found to have benefits as regards the postoperative complication rate (p < 0.001), pain at rest rate (p = 0.011), and pain on exertion rate (p < 0.001). In the present registry study, no significant difference was identified in the recurrence rates between the TEP and Lichtenstein technique. TEP was found to have benefits compared with Lichtenstein repair as regards the postoperative complication rates, pain at rest, and pain on exertion.
引言
在欧洲疝学会指南的更新中，尽管一项荟萃分析发现经腹膜前修补术（TEP）与李金斯坦手术相比复发率更高，但开放李金斯坦手术和内镜技术仍继续被推荐为男性单侧原发性腹股沟疝修补术的首选手术技术。指南制定小组做出该决定是因为荟萃分析中纳入的一项随机对照试验中的一位外科医生复发率非常高。因此，这项基于登记数据的研究现在比较了TEP与李金斯坦修补术的结果。
患者与方法
对疝病登记处的数据进行分析，比较了接受原发性单侧腹股沟疝修补术的男性患者采用TEP或开放李金斯坦修补术所收集的前瞻性数据。纳入标准为最低年龄16岁、男性患者、原发性单侧腹股沟疝、择期手术以及有1年随访数据。2009年9月1日至2013年8月31日期间共纳入17388例患者。其中，10555例（60.70%）接受了李金斯坦修补术，6833例（39.30%）接受了TEP修补术。
结果
多变量分析显示，手术技术对复发率（p = 0.146）或慢性疼痛率（p = 0.560）没有任何显著影响。两种技术之间与并发症相关的再次手术率也没有显著差异（p = 0.084）。但发现TEP在术后并发症发生率（p < 0.001）、静息痛发生率（p = 0.011）和用力时疼痛发生率（p < 0.001）方面具有优势。在本登记研究中，TEP和李金斯坦技术之间的复发率没有显著差异。与李金斯坦修补术相比，TEP在术后并发症发生率、静息痛和用力时疼痛方面具有优势。
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