腹腔镜巨大食管裂孔疝修补术中补片与缝合修复盆底成形术的系统评价和荟萃分析
A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair.
作者信息
Tam Vernissia, Winger Daniel G, Nason Katie S
机构信息
Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA, USA.
Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Am J Surg. 2016 Jan;211(1):226-38. doi: 10.1016/j.amjsurg.2015.07.007. Epub 2015 Sep 18.
BACKGROUND
Equipoise exists regarding whether mesh cruroplasty during laparoscopic large hiatal hernia repair improves symptomatic outcomes compared with suture repair.
DATA SOURCE
Systematic literature review (MEDLINE and EMBASE) identified 13 studies (1,194 patients; 521 suture and 673 mesh) comparing mesh versus suture cruroplasty during laparoscopic repair of large hiatal hernia. We abstracted data regarding symptom assessment, objective recurrence, and reoperation and performed meta-analysis.
CONCLUSIONS
The majority of studies reported significant symptom improvement. Data were insufficient to evaluate symptomatic versus asymptomatic recurrence. Time to evaluation was skewed toward longer follow-up after suture cruroplasty. Odds of recurrence (odds ratio .51, 95% confidence interval .30 to .87; overall P = .014) but not need for reoperation (odds ratio .42, 95% confidence interval .13 to 1.37; overall P = .149) were less after mesh cruroplasty. Quality of evidence supporting routine use of mesh cruroplasty is low. Mesh should be used at surgeon discretion until additional studies evaluating symptomatic outcomes, quality of life, and long-term recurrence are available.
背景
关于腹腔镜巨大食管裂孔疝修补术中使用补片进行盆底修复与缝合修复相比是否能改善症状性结局，目前存在 equipoise。
数据来源
系统文献综述（MEDLINE 和 EMBASE）确定了 13 项研究（1194 例患者；521 例行缝合修复，673 例行补片修复），比较了腹腔镜巨大食管裂孔疝修补术中补片与缝合盆底修复的效果。我们提取了有关症状评估、客观复发和再次手术的数据，并进行了荟萃分析。
结论
大多数研究报告症状有显著改善。数据不足以评估有症状复发与无症状复发情况。评估时间倾向于缝合盆底修复术后更长的随访时间。补片盆底修复术后复发几率（优势比 0.51，95%置信区间 0.30 至 0.87；总体 P = 0.014）较低，但再次手术需求（优势比 0.42，95%置信区间 0.13 至 1.37；总体 P = 0.149）并非如此。支持常规使用补片盆底修复的证据质量较低。在有更多评估症状性结局、生活质量和长期复发的研究之前，应根据外科医生的判断使用补片。
Zotero 插件