摘要
目的采用贝叶斯网状meta分析方法评价腹腔镜经腹腹膜前疝修补术中不同补片固定方式的有效性和安全性。方法检索CNKI、WanFang Data、VIP、CBM、the Cochrane Library、PubMed、Embase和Web of Science数据库,搜集腹腔镜经腹腹膜前疝修补术中补片不同固定方式间比较的随机对照试验(randomized controlled trial,RCT)研究,检索时限为建库至2022年3月1日,由两名研究者独立筛选文献、提取资料并进行偏倚风险评估,采用R4.1.2软件进行贝叶斯网状meta分析。结果最终纳入29项RCT研究,包括4095例患者。网状meta分析结果显示:术后发生慢性疼痛风险钉枪固定高于不固定[OR=0.06,95%CI(0.01,0.26),P<0.001]、医用胶固定[OR=0.21,95%CI(0.04,0.53),P=0.001]和自固定[OR=0.09,95%CI(0.01,0.52),P=0.009];术后发生慢性疼痛风险缝线固定高于不固定[OR=0.10,95%CI(0.01,0.70),P=0.020];术后视觉模拟评分法(visual analogue scale,VAS)评分钉枪固定高于不固定[MD=–0.90,95%CI(–1.49,–0.33),P=0.002]和医用胶固定[MD=–0.9295%CI(–1.35,–0.49),P<0.001];缝线固定术后VAS评分高于不固定[MD=–0.83,95%CI(–1.61,–0.08),P=0.030]和医用胶固定[MD=–0.85,95%CI(–1.56,–0.13),P=0.020]。不同固定方式间血清肿和血肿发生率、住院时间以及疝复发方面比较差异均无统计学意义(P>0.05)。结论现有证据表明,医用胶和自固定补片在降低术后慢性疼痛方面具有一定优势,可能是腹腔镜经腹腹膜前疝修补术中较优的补片固定方式;不固定补片不会增加术后复发的风险,可以在临床中应用。该结论尚需大样本、长期随访及高质量的RCT进一步验证。
Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair(TAPP)by using network meta-analysis.Methods CNKI,WanFang Data,VIP,CBM,the Cochrane Library,PubMed,Embase,and Web of Science databases were retrieved to collect randomized controlled trials(RCTs)studies comparing different fixation methods of patches in laparoscopic TAPP.The retrieval time limit was from the establishment of the database to March 1,2022.After two researchers independently screened the literatures,extracted the data,and evaluated the bias risk,Bayesian network meta-analysis was conducted by using R4.1.2 software.Results Twenty-nine RCTs were included,including 4095 patients.The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation[OR=0.06,95%CI(0.01,0.26),P<0.001],glue fixation[OR=0.21,95%CI(0.04,0.53),P=0.001]and selfgripping mesh[OR=0.09,95%CI(0.01,0.52),P=0.009],the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation[OR=0.10,95%CI(0.01,0.70),P=0.020].Postoperative visual analogue scale of staples fixation was higher than those of no fixation[MD=–0.90,95%CI(–1.49,–0.33),P=0.002]and glue fixation[MD=–0.92,95%CI(–1.35,–0.49),P<0.001],the postoperative visual analogue scale with suture fixation was higher than those of no fixation[MD=–0.83,95%CI(–1.61,–0.08),P=0.030]and glue fixation[MD=–0.85,95%CI(–1.56,–0.13),P=0.020].There was no significant difference in the incidence of seroma and hematoma,hospital stay and hernia recurrence among different fixation methods.Conclusions The network meta-analysis shows that medical glue and selfgripping mesh have certain advantages in reducing chronic pain after surgery,which may be the better patch fixation method in TAPP.The non fixation mesh will not increase the risk of postoperative recurrence,and can be used in clinical practice.This conclusion needs to be further verified by large sample,long-term follow-up and high-quality RCTs.
作者
蒋维荣
孟勇
高明清
俞永江
李瑞
陈文浩
徐镇
JIANG Weirong;MENG Yong;GAO Mingqing;YU Yongjiang;LI Rui;CHEN Wenhao;XU Zhen(The Fourth Department of General Surgery,Xi’an No.3 Hospital,The Affiliated Hospital of Northwest University,Xi’an 710018,P.R.China;Northwest University School of Medicine,Xi’an 710069,P.R.China;Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730030,P.R.China;The First School of Clinical Medicine of Lanzhou University,Lanzhou 730030,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2023年第2期204-213,共10页
Chinese Journal of Bases and Clinics In General Surgery
作者简介
通信作者:孟勇,Email:my176@126.com。
