专题研究(Monographic Study)

无张力性疝修补术中切除髂腹股沟神经疗效的Meta分析

Published at: 2017年第26卷第10期

王紫括 1 , 徐靖 2 , 张新 2 , 王荫龙 2 , 吴易锋 1 , 孙广革 1
1 南开大学医学院,天津 300071
2 天津市人民医院 普通外科,天津 300121
通讯作者 靖 徐 Email: xujingdoc@126.com
DOI: 10.3978/j.issn.1005-6947.2017.10.003
基金:

摘要

目的:评价开放式无张力性疝修补术中预防性切除髂腹股沟神经的临床有效性及安全性。方法:检索中外数据库2017年3月之前公开发表的有关评价髂腹股沟神经切除的临床意义的随机对照试验,提取据进行Meta分析。结果:共纳入13篇文献,共2 033例患者,其中神经切除组1 007例,神经保留组1 026例。与神经保留组比较,神经切除组术后近期和中期疼痛感(SMD=-0.54,95% CI=-0.85~-0.23;SMD=-0.25,95% CI=-0.40~-0.10)均明显降低(均P<0.05),远期疼痛感(SMD=-0.21,95% CI=-0.47~0.05)差异无统计学意义(P>0.05);术后近期、中期、远期麻木率(RD=0.00,95% CI=-0.06~0.07;RD=0.01,95% CI=-0.03~0.06;RD=0.00,95% CI=-0.03~0.02)与感觉障碍率(RD=0.05,95% CI= -0.03~0.12;RD=0.02,95% CI=-0.02~0.06;RD=0.01,95% CI=-0.02~0.04)均无统计学差异(均P>0.05);术后次要并发症发生率(RR=0.71,95% CI=0.48~1.06)亦无统计学差异(P>0.05)。结论:在开放式无张力性疝修补术中预防性切除髂腹股沟神经能够有效降低术后近期、中期疼痛感,且不增加腹股沟区感觉异常的风险。


Meta-analysis of efficacy of ilioinguinal neurectomy in inguinal hernia repair

Abstract

Objective: To evaluate the clinical efficacy and safety of prophylactic ilioinguinal neurectomy in open tension-free inguinal hernia repair. Methods: The randomized controlled trials estimating the clinical significance of prophylactic ilioinguinal neurectomy publically published before March 2017 were searched in several national and international databases. A meta-analysis was performed on the extracted data. Results: A total of 13 studies were included, involving 2 033 patients with 1 007 cases in nerve excision group and 1 026 cases in nerve preservation group. In nerve excision group compared nerve preservation group, the short- and mid-term postoperative pain (SMD=–0.54, 95% CI=–0.85––0.23; SMD=–0.25, 95% CI=–0.40––0.10) were significantly reduced (both P<0.05), but the long-term postoperative pain (SMD=–0.21, 95% CI=–0.47–0.05) showed no significant difference (P>0.05); all the short-, mid- and long-term rates of postoperative numbness (RD=0.00, 95% CI=–0.06 0.07; RD=0.01, 95% CI=–0.03 0.06; RD=0.00, 95% CI=–0.03–0.02) and sensory disturbance (RD=0.05, 95% CI=–0.03–0.12; RD=0.02, 95% CI=–0.02–0.06; RD=0.01, 95% CI=–0.02–0.04) showed no significant difference (all P>0.05); the incidence of minor postoperative complications (RR=0.71, 95% CI=0.48–1.06) also showed no significant difference (P>0.05). Conclusion: Prophylactic ilioinguinal neurectomy in open inguinal hernia repair can effectively reduce the short- and mid-term pain, with no increase of risk of abnormal sensations in the inguinal area.


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引用

引用本文: 紫括 王, 靖 徐, 新 张, 荫龙 王, 易锋 吴, 广革 孙. 无张力性疝修补术中切除髂腹股沟神经疗效的Meta分析[J]. 中国普通外科杂志, 2017, 26(10): 1237-1246.
Cite this article as: WANG Zikuo, XU Jing, ZHANG Xin, WANG Yinlong, WU Yifeng, SUN Guangge . Meta-analysis of efficacy of ilioinguinal neurectomy in inguinal hernia repair[J]. Chin J Gen Surg, 2017, 26(10): 1237-1246.