推荐在开放式腹股沟（Lichtenstein）疝修补术中使用轻质网片：系统评价和荟萃分析。
Lightweight mesh is recommended in open inguinal (Lichtenstein) hernia repair: A systematic review and meta-analysis.
机构信息
Department of Surgery, Hernia Clinic, Diakonessenhuis, Zeist, the Netherlands.
Department of Surgery, Rijnstate, Arnhem, the Netherlands.
出版信息
Surgery. 2020 Mar;167(3):581-589. doi: 10.1016/j.surg.2019.08.021. Epub 2019 Oct 28.
BACKGROUND
The use of lightweight mesh for inguinal hernia repair has been suggested to be preferable compared with heavyweight mesh. Nevertheless, surgeons do not use lightweight mesh routinely, possibly owing to the higher price and lack of confidence in evaluation of previous evidence. The aim of this systematic review and meta-analysis is to update the available randomized controlled trials and provide a recommendation on the use of lightweight mesh or heavyweight mesh in open inguinal hernia repair.
METHODS
A literature search was conducted in May 2019 in MEDLINE, Embase and the Cochrane library for randomized controlled trials comparing lightweight (≤50 g/m) and heavyweight (>70 g/m) mesh in patients undergoing open (Lichtenstein) surgery for uncomplicated inguinal hernias. Outcomes were recurrences (overall, after direct or indirect repair), chronic pain (analyzing any and severe pain), and the feeling of a foreign body. The level of evidence was assessed using GRADE. Risk ratios and 95% confidence intervals were calculated by random effect meta-analyses.
RESULTS
Twenty-one randomized controlled trials involving 4,576 patients (lightweight mesh 2,257 vs heavyweight mesh 2,319) were included. Follow-up ranged from 3 to 60 months. No difference between lightweight mesh and heavyweight mesh was determined for recurrence rates (lightweight mesh 42 of 2,068 and heavyweight mesh 34 of 2,132; risk ratios 1.22; 95% confidence interval, 0.76-1.96) or severe pain (lightweight mesh 14 of 1,517 and heavyweight mesh 26 of 1,591; risk ratios 0.73; 95% confidence interval, 0.38-1.41). A significant reduction was seen for any pain after lightweight mesh (234 of 1,603) compared with heavyweight mesh (322 of 1,683; risk ratios 0.78; 95% confidence interval, 0.64-0.96) and for the feeling of a foreign body (lightweight mesh 130 of 1,053 and heavyweight mesh 209 of 1,035; risk ratios 0.64; 95% confidence interval, 0.51-0.80).
CONCLUSION
Lightweight mesh should be used in open (Lichtenstein) inguinal hernia repair.
背景
与重质网片相比，使用轻质网片进行腹股沟疝修补术被认为是更优的选择。然而，外科医生并没有常规使用轻质网片，这可能是由于其价格较高，以及对之前证据评估的信心不足。本系统评价和荟萃分析的目的是更新现有的随机对照试验，并就开放式（Lichtenstein）腹股沟疝修补术中使用轻质网片或重质网片提供建议。
方法
2019 年 5 月，我们在 MEDLINE、Embase 和 Cochrane 图书馆中进行了文献检索，以查找比较轻质（≤50 g/m）和重质（>70 g/m）网片在接受开放式（Lichtenstein）手术治疗无并发症腹股沟疝的患者中的随机对照试验。结局包括复发（整体、直接或间接修复后）、慢性疼痛（分析任何和严重疼痛）以及异物感。使用 GRADE 评估证据水平。采用随机效应荟萃分析计算风险比和 95%置信区间。
结果
共纳入 21 项随机对照试验，涉及 4576 名患者（轻质网片 2257 例，重质网片 2319 例）。随访时间为 3 至 60 个月。在复发率方面，轻质网片与重质网片无差异（轻质网片 2068 例中有 42 例，重质网片 2132 例中有 34 例；风险比 1.22；95%置信区间，0.76-1.96）或严重疼痛（轻质网片 1517 例中有 14 例，重质网片 1591 例中有 26 例；风险比 0.73；95%置信区间，0.38-1.41）。与重质网片相比，轻质网片在任何疼痛（轻质网片 1603 例中有 234 例，重质网片 1683 例中有 322 例；风险比 0.78；95%置信区间，0.64-0.96）和异物感（轻质网片 1053 例中有 130 例，重质网片 1035 例中有 209 例；风险比 0.64；95%置信区间，0.51-0.80）方面的发生率显著降低。
结论
在开放式（Lichtenstein）腹股沟疝修补术中应使用轻质网片。
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