两种常见腹腔镜腹股沟疝修补术式的安全性：一项纳入随机临床试验的系统评价与Meta分析的更新研究

Safety of two common laparoscopic inguinal herniorrhaphy approaches: an updated systematic review with meta-analysis of randomized clinical trials.

作者信息

Hung Tsung-Yu, Wu Chien-Chih, Chen Li-Siou, Kang Yi-No

机构信息

Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei.

School of Medicine, College of Medicine, Taipei Medical University, Taipei.

出版信息

Transl Androl Urol. 2020 Oct;9(5):2007-2021. doi: 10.21037/tau-20-629.

BACKGROUND

Previous evidence indicated that total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) are advantageous in efficacy of inguinal herniorrhaphy. Therefore, our aim in this study was to evaluate the association of the two laparoscopic approaches on safety of inguinal herniorrhaphy.

METHODS

In this update study, we searched the Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science and identified randomized clinical trials comparing complications in TEP and TAPP herniorrhaphy. We mainly used Peto odds ratio with 95% confidence interval (CI) for meta-analysis because of zero-cell.

RESULTS

Fourteen eligible trials recruited 659 and 682 patients in TEP and TAPP respectively. In overall pooling, although TEP had a higher seroma rate than TAPP (Peto odds ratio =2.01; 95% CI, 1.39 to 2.91), it had a lower scrotal/cord edema rates at immediate postoperative (Peto odds ratio =0.22; 95% CI, 0.09 to 0.57) and 1 week after inguinal hernia repair (Peto odds ratio =0.58; 95% CI, 0.37 to 0.91) than TAPP.

CONCLUSIONS

TEP and TAPP have their own advantages in inguinal herniorrhaphy. TAPP was associated with a lower seroma rate, and TEP was associated with a lower edema rate. Therefore, shared decision-making on laparoscopic inguinal herniorrhaphy with TEP and TAPP is still needed.

背景

先前的证据表明，完全腹膜外修补术（TEP）和经腹腹膜前修补术（TAPP）在腹股沟疝修补术的疗效方面具有优势。因此，我们本研究的目的是评估这两种腹腔镜手术方式与腹股沟疝修补术安全性之间的关联。

方法

在这项更新研究中，我们检索了考克兰图书馆、EMBASE、PubMed、Scopus和科学网，并确定了比较TEP和TAPP疝修补术并发症的随机临床试验。由于存在零单元格，我们主要使用Peto比值比及95%置信区间（CI）进行荟萃分析。

结果

14项符合条件的试验分别纳入了659例接受TEP手术和682例接受TAPP手术的患者。在总体汇总分析中，尽管TEP的血清肿发生率高于TAPP（Peto比值比=2.01；95%CI，1.39至2.91），但在术后即刻（Peto比值比=0.22；95%CI，0.09至0.57）以及腹股沟疝修补术后1周时（Peto比值比=0.58；95%CI，0.37至0.91），TEP的阴囊/精索水肿发生率低于TAPP。