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开放式腹股沟疝修补术中自固定网片与缝合网片的比较:长期结果的荟萃分析。

Comparison of self-gripping mesh and sutured mesh in open inguinal hernia repair: A meta-analysis of long-term results.

机构信息

Department of General Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

Department of General Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

出版信息

Surgery. 2018 Feb;163(2):351-360. doi: 10.1016/j.surg.2017.08.003. Epub 2017 Oct 10.

Abstract

BACKGROUND

Complications after inguinal hernioplasty pose a significant burden on individual patients and society because of high numbers of repair procedures. Recently, the long-term results of a self-gripping ProGrip mesh for open inguinal hernia repair have become available. The aim of this meta-analyses was to compare these long-term results with the results of a Lichtenstein hernioplasty with a sutured mesh focusing on chronic pain, recurrence rate, foreign body sensation, and operation duration.

METHODS

A systematic review of the literature was undertaken to identify randomized controlled trials comparing open inguinal hernia repair with a self-gripping ProGrip mesh and a conventional Lichtenstein hernioplasty.

RESULTS

In the present meta-analysis, the outcomes of 10 randomized controlled trials enrolling 2,541 patients were pooled. The mean follow-up was 24 months (range 6-72 months). There was no significant difference in the incidence of chronic pain (odds ratio = 0.93; 95% confidence interval, 0.74-1.18), recurrence (odds ratio = 1.34; 95% confidence interval, 0.82-2.19), or foreign body sensation (odds ratio = 0.82; 95% confidence interval, 0.65-1.03), between the self-gripping mesh and sutured mesh group at all follow-up time points. The mean operating time was significantly shorter (odds ratio = -7.58; 95% confidence interval, -9.58 to -5.58) in the self-gripping mesh group.

CONCLUSION

The self-gripping mesh has comparable results with a sutured mesh regarding the incidence of chronic postoperative inguinal pain, recurrence and foreign body sensation. However, long-term results still are based on relatively small patient numbers and outcomes measures are heterogenic. The main advantage of the self-gripping mesh is the consistently significantly reduced operation time.

摘要

背景

由于修复手术数量较多,腹股沟疝修补术后并发症给个体患者和社会带来了巨大负担。最近,一种自固定 ProGrip 网片用于开放式腹股沟疝修补术的长期结果已经公布。本荟萃分析的目的是比较这些长期结果与使用缝合网片的 Lichtenstein 疝修补术的结果,重点关注慢性疼痛、复发率、异物感和手术时间。

方法

对文献进行系统回顾,以确定比较开放式腹股沟疝修补术与自固定 ProGrip 网片和传统 Lichtenstein 疝修补术的随机对照试验。

结果

本荟萃分析共纳入 10 项随机对照试验,共 2541 例患者。平均随访时间为 24 个月(范围 6-72 个月)。在所有随访时间点,慢性疼痛(优势比=0.93;95%置信区间,0.74-1.18)、复发(优势比=1.34;95%置信区间,0.82-2.19)或异物感(优势比=0.82;95%置信区间,0.65-1.03)的发生率在自固定网片和缝合网片组之间没有显著差异。自固定网片组的平均手术时间明显缩短(优势比=-7.58;95%置信区间,-9.58 至-5.58)。

结论

自固定网片在慢性术后腹股沟疼痛、复发和异物感的发生率方面与缝合网片具有相当的结果。然而,长期结果仍基于相对较少的患者数量,且结果测量具有异质性。自固定网片的主要优势是手术时间始终显著缩短。

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