经腹补片修补术与全腹膜外补片修补术与经腹腹膜外补片修补术治疗原发性单侧腹股沟疝的疗效比较：基于登记的、倾向评分匹配的 57906 例患者比较。
Lichtenstein Versus Total Extraperitoneal Patch Plasty Versus Transabdominal Patch Plasty Technique for Primary Unilateral Inguinal Hernia Repair: A Registry-based, Propensity Score-matched Comparison of 57,906 Patients.
机构信息
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
Winghofer Medicum, Hernia Center, Rottenburg am Neckar, Germany.
出版信息
Ann Surg. 2019 Feb;269(2):351-357. doi: 10.1097/SLA.0000000000002541.
OBJECTIVE
Outcome comparison of the Lichtenstein, total extraperitoneal patch plasty (TEP), and transabdominal patch plasty (TAPP) techniques for primary unilateral inguinal hernia repair.
BACKGROUND
For comparison of these techniques the number of cases included in meta-analyses of randomized controlled trials is limited. There is therefore an urgent need for more comparative data.
METHODS
In total, 57,906 patients with a primary unilateral inguinal hernia and 1-year follow up from the Herniamed Registry were selected between September 1, 2009 and February 1, 2015. Using propensity score matching, 12,564 matched pairs were formed for comparison of Lichtenstein versus TEP, 16,375 for Lichtenstein versus TAPP, and 14,426 for TEP versus TAPP.
RESULTS
Comparison of Lichtenstein versus TEP revealed disadvantages for the Lichtenstein operation with regard to the postoperative complications (3.4% vs 1.7%; P < 0.001), complication-related reoperations (1.1% vs 0.8%; P = 0.008), pain at rest (5.2% vs 4.3%; P = 0.003), and pain on exertion (10.6% vs 7.7%; P < 0.001). TEP had disadvantages in terms of the intraoperative complications (0.9% vs 1.2%; P = 0.035). Likewise, comparison of Lichtenstein versus TAPP showed disadvantages for the Lichtenstein operation with regard to the postoperative complications (3.8% vs 3.3%; P = 0.029), complication-related reoperations (1.2% vs 0.9%; P = 0.019), pain at rest (5% vs 4.5%; P = 0.029), and on exertion (10.2% vs 7.8%; P < 0.001).
CONCLUSIONS
TEP and TAPP were found to have advantages over the Lichtenstein operation.
目的
比较经腹腹膜前修补术（TAPP）和完全腹膜外修补术（TEP）与经腹疝修补术（Lichtenstein）治疗单侧腹股沟疝的疗效。
背景
为了比较这些技术，荟萃分析纳入的随机对照试验病例数有限。因此，我们迫切需要更多的比较数据。
方法
本研究从 Herniamed 注册中心选取了 2009 年 9 月 1 日至 2015 年 2 月 1 日期间的 57906 例单侧腹股沟疝患者和 1 年随访资料。采用倾向评分匹配，比较 Lichtenstein 与 TEP 的患者有 12564 对，Lichtenstein 与 TAPP 的患者有 16375 对，TEP 与 TAPP 的患者有 14426 对。
结果
Lichtenstein 与 TEP 相比，Lichtenstein 手术的术后并发症发生率较高（3.4% vs. 1.7%；P < 0.001），并发症相关的再次手术率较高（1.1% vs. 0.8%；P = 0.008），静息痛发生率较高（5.2% vs. 4.3%；P = 0.003），活动痛发生率较高（10.6% vs. 7.7%；P < 0.001）。TEP 手术的术中并发症发生率较高（0.9% vs. 1.2%；P = 0.035）。同样，Lichtenstein 与 TAPP 相比，Lichtenstein 手术的术后并发症发生率较高（3.8% vs. 3.3%；P = 0.029），并发症相关的再次手术率较高（1.2% vs. 0.9%；P = 0.019），静息痛发生率较高（5% vs. 4.5%；P = 0.029），活动痛发生率较高（10.2% vs. 7.8%；P < 0.001）。
结论
TAPP 和 TEP 与 Lichtenstein 手术相比具有优势。
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