局部、区域或全身麻醉下腹股沟疝修补术后尿潴留和死亡率的网状荟萃分析。

Network meta-analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

机构信息

Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.

Clinical Research Unit, Statistical Section, Department of Haematology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.

出版信息

Br J Surg. 2020 Jan;107(2):e91-e101. doi: 10.1002/bjs.11308. Epub 2019 Oct 1.

DOI:10.1002/bjs.11308

PMID:31573087

Abstract

BACKGROUND

Urinary retention and mortality after open repair of inguinal hernia may depend on the type of anaesthesia. The aim of this study was to investigate possible differences in urinary retention and mortality in adults after Lichtenstein repair under different types of anaesthesia.

METHODS

Systematic searches were conducted in the Cochrane, PubMed and Embase databases, with the last search on 1 August 2018. Eligible studies included adult patients having elective unilateral inguinal hernia repair by the Lichtenstein technique under local, regional or general anaesthesia. Outcomes were urinary retention and mortality, which were compared between the three types of anaesthesia using meta-analyses and a network meta-analysis.

RESULTS

In total, 53 studies covering 11 683 patients were included. Crude rates of urinary retention were 0·1 (95 per cent c.i. 0 to 0·2) per cent for local anaesthesia, 8·6 (6·6 to 10·5) per cent for regional anaesthesia and 1·4 (0·6 to 2·2) per cent for general anaesthesia. No death related to the type of anaesthesia was reported. The network meta-analysis showed a higher risk of urinary retention after both regional (odds ratio (OR) 15·73, 95 per cent c.i. 5·85 to 42·32; P < 0·001) and general (OR 4·07, 1·07 to 15·48; P = 0·040) anaesthesia compared with local anaesthesia, and a higher risk after regional compared with general anaesthesia (OR 3·87, 1·10 to 13·60; P = 0·035). Meta-analyses showed a higher risk of urinary retention after regional compared with local anaesthesia (P < 0·001), but no difference between general and local anaesthesia (P = 0·08).

CONCLUSION

Local or general anaesthesia had significantly lower risks of urinary retention than regional anaesthesia. Differences in mortality could not be assessed as there were no deaths after elective Lichtenstein repair. Registration number: CRD42018087115 ( https://www.crd.york.ac.uk/prospero).

摘要

背景

开放腹股沟疝修补术后尿潴留和死亡率可能取决于麻醉类型。本研究旨在探讨成人在不同类型麻醉下接受李金斯坦修复术后尿潴留和死亡率的差异。

方法

系统检索 Cochrane、PubMed 和 Embase 数据库，最后一次检索日期为 2018 年 8 月 1 日。纳入研究为成人单侧腹股沟疝采用李金斯坦技术行择期修补术，接受局部、区域或全身麻醉。采用荟萃分析和网络荟萃分析比较三种麻醉方式的尿潴留和死亡率。

结果

共纳入 53 项研究，涵盖 11683 例患者。局部麻醉的尿潴留粗发生率为 0.1%（95%可信区间 0 至 0.2），区域麻醉为 8.6%（6.6 至 10.5），全身麻醉为 1.4%（0.6 至 2.2）。未报告与麻醉类型相关的死亡。网络荟萃分析显示，区域麻醉（比值比 15.73，95%可信区间 5.85 至 42.32；P<0.001）和全身麻醉（比值比 4.07，1.07 至 15.48；P=0.040）后尿潴留的风险均高于局部麻醉，区域麻醉后高于全身麻醉（比值比 3.87，1.10 至 13.60；P=0.035）。荟萃分析显示，区域麻醉后尿潴留的风险高于局部麻醉（P<0.001），但全身麻醉与局部麻醉之间无差异（P=0.08）。