University of Edinburgh, Edinburgh, United Kingdom; Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.
Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore.
J Pediatr Surg. 2022 Nov;57(11):527-533. doi: 10.1016/j.jpedsurg.2022.07.001. Epub 2022 Jul 15.
To evaluate the clinical outcomes of herniotomy in preterm infants undergoing early versus delayed repair, the risk factors for complications, and to identify best timing of surgery.
Medline, Embase and Central databases were searched from inception until 25 Jan 2021 to identify publications comparing the timing of neonatal inguinal hernia repair between early intervention (before discharge from first hospitalization) and delayed (after first hospitalisation discharge) intervention. Inclusion criteria was preterm infants diagnosed with inguinal hernia during neonatal intensive care unit admission. Results were analyzed using fixed and random effects meta-analysis (RevManv5.4).
Out of 721 articles found, six studies were included in the meta-analysis. Patients in the early group had lower odds of developing incarceration [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.34-0.55, I = 0%, p < 0.001]; but higher risk of post-operative respiratory complications (OR 4.36, 95% CI 2.13-8.94, I = 40%, p < 0.001). No significant differences were reported in recurrence rate (OR 3.10, 95% CI 0.90-10.64, I = 0%, p = 0.07) and surgical complication rate (OR 0.94, 95% CI 0.18-4.83, I = 0%, p = 0.94) between early and delayed groups.
While early inguinal hernia repair in preterm infants reduces the risk of incarceration, it increases the risk of post-operative respiratory complications compared to delayed repair. Surgeons should discuss the risks and benefits of delaying inguinal hernia repair with the caregivers to make an informed decision best suited to the patient physiology and circumstances.
Treatment study, level 3.
评估早产儿行疝囊切开术的临床转归，包括早期修复与延迟修复的并发症风险因素，并确定最佳手术时机。
检索 Medline、Embase 和 Cochrane 数据库，检索时间从建库至 2021 年 1 月 25 日，收集比较新生儿重症监护病房内早产儿接受早期（第 1 次住院期间）与延迟（第 1 次住院后）疝囊切开术的相关研究。纳入标准为在新生儿重症监护病房住院期间被诊断为腹股沟疝的早产儿。采用固定效应模型和随机效应模型进行 Meta 分析（RevMan5.4 软件）。
共检索到 721 篇文献，其中 6 篇文献符合纳入标准。早期组患儿发生嵌顿的可能性较低[比值比（OR）0.43，95%置信区间（CI）0.34-0.55，I²=0%，p<0.001]，但术后发生呼吸系统并发症的风险较高[OR 4.36，95%CI 2.13-8.94，I²=40%，p<0.001]。两组患儿在复发率[OR 3.10，95%CI 0.90-10.64，I²=0%，p=0.07]和手术并发症发生率[OR 0.94，95%CI 0.18-4.83，I²=0%，p=0.94]方面差异均无统计学意义。
与延迟修复相比，早期修复可降低早产儿腹股沟疝嵌顿的风险，但会增加术后呼吸系统并发症的风险。外科医生应与患儿家属讨论延迟修复的风险和获益，以便根据患儿的生理状况和具体情况做出最适合的决策。
治疗研究，证据级别 3。
