目的:评价及比较腹腔镜与开放式无张力手术治疗成人单侧初发腹股沟疝的疗效.方法:计算机检索PubMed、EMBASE、Web of Science、中国生物医学数据库和维普数据库,检索时间为2006年-2016年.收集有关腹腔镜与开放式无张力手术治疗成人单侧初发腹股沟疝的随机对照临床试验报道,由2名评价员根据5.0.1版《Cochrane干预措施系统评价手册》对收集的文献进行独立评价,并用RevMan 5.3软件进行数据提取与分析.结果:共纳入13篇文献,包含12个临床试验,以及3 200例成人单侧初发腹股沟疝患者.Meta分析提示:与开放式无张力手术相比,腹腔镜手术组的住院费用较高(SMD=4.99,95％CI 3.13～6.85,P<0.001),手术后并发症发生率(RR=0.82,95％CI 0.68～0.98,P=0.03)、术后疼痛评分(MD=-1.67,95％CI-2.29～-1.05,P<0.001)和慢性疼痛发生率(RR=0.40,95％CI 0.23～0.69,P=0.001)降低;但在手术时间(MD=0.14,95％CI 2.69～2.97,P=0.92)和复发率(RR=0.96,95％CI 0.32～2.88,P=0.06)方面,2种手术方式差异无统计学意义.结论:与开放式手术相比,腹腔镜手术治疗成人单侧初发腹股沟疝有优势但费用较高,需根据具体情况来选择合适的术式.%Objective:To evaluate and compare the efficacy of laparoscopic and open tension-free surgery for adult unilateral primary inguinal hernia.Methods:Randomized controlled trial(RCT)reports published from 2006 to 2016 were searched in the PubMed,EMBASE,Web of Science,CBM and VIP databases.Data related to the clinical outcome,which compared the efficacy of laparoscopic and open surgery for adult unilateral primary inguinal hernia,were independently extracted and analyzed by two reviewers according to Cochrane Handbook for Systematic Reviews of Interventions 5.0.1.Statistical analysis was performed using RevMan 5.3 software.Objective:A total of 3 200 adult patients with unilateral primary inguinal hernia from 12 RCTs in 13 papers were enrolled in this Meta-analysis.Compared with open surgery,the cost of hospitalization in laparoscopic repair group increased(SMD=4.99,95％CI 3.13-6.85,P<0.001),and the rates of complication occurrence(RR=0.82,95％CI 0.68-0.98,P=0.03),NRS(MD=-1.67,95％CI-2.29——1.05,P<0.001)and persistent pain recurrence(RR=0.40,95％CI 0.23-0.69,P=0.001)reduced.However,there was no significant difference in the operation time(MD=0.14,95％CI 2.69-2.97,P=0.92)and the recurrence rate(RR=0.96,95％CI 0.32-2.88,P=0.06).Conclusions:Compared with open surgery,laparoscopic surgery is superior for adult primary unilateral inguinal hernia,but with higher cost.Accordingly,the appropriate surgical operation should be selected.
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