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中华胃食管反流病电子杂志 ›› 2015, Vol. 02 ›› Issue (03) : 158 -164. doi: 10.3877/cma.j.issn.1674-6899.2015.03.010

所属专题: 文献

循证医学

传统缝合修补对比补片修补治疗巨大食管裂孔疝的Meta分析
张扬1, 袁志民1, 任捷艺1, 邓先兆1, 康杰1, 伍波1, 樊友本1,()   
  1. 1. 200233 上海交通大学附属第六人民医院普外科
  • 收稿日期:2015-07-14 出版日期:2015-08-15
  • 通信作者: 樊友本

Meta-analysis of suture repair versus mesh repair for large hiatal hernia

Yang Zhang1, Zhimin Yuan1, RenJieyi1, Xianzhao Deng1, Jie Kang1, Bo Wu1, Youben Fan1,()   

  1. 1. Department of General Surgery, Sixth People′s Hospital affiliated to Shanghai Jiao Tong University, Shanghai 200233, Chian
  • Received:2015-07-14 Published:2015-08-15
  • Corresponding author: Youben Fan
  • About author:
    Corresponding author: Fan Youben, Email:
引用本文:

张扬, 袁志民, 任捷艺, 邓先兆, 康杰, 伍波, 樊友本. 传统缝合修补对比补片修补治疗巨大食管裂孔疝的Meta分析[J/OL]. 中华胃食管反流病电子杂志, 2015, 02(03): 158-164.

Yang Zhang, Zhimin Yuan, RenJieyi, Xianzhao Deng, Jie Kang, Bo Wu, Youben Fan. Meta-analysis of suture repair versus mesh repair for large hiatal hernia[J/OL]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2015, 02(03): 158-164.

目的

本研究通过Meta分析对传统缝合修补与补片修补在治疗巨大食管裂孔疝的效果和安全性进行评价。

方法

检索Pubmed、Embase和Cochrane数据库所有已发表的有关传统缝合修补对比补片修补治疗巨大食管裂孔疝的临床研究。主要评价指标为复发率和并发症。

结果

5项临床试验符合标准入选Meta分析,共有465名研究对象纳入分析。合并分析表明,初次食管裂孔疝传统缝合修补组的复发率是补片修补组的2.5~4倍。长期观察(>6个月)表明,补片修补组复发危险度OR=0.48(95% CI,0.22~1.01,P=0.05);随访期内没有观察到因补片引起的脏器损伤。

结论

补片修补治疗巨大食管裂孔疝是安全的,在降低术后复发率方面优于传统缝合修补,但长期效果有待更多高质量的长期随机对照试验来进一步明确。

Objective

This review is to provide an up-to-date assessment of superiority between suture repair and mesh repair of large hiatal hernia.

Methods

An Internet search was performed of the Pubmed, Embase, and Cochrane Library databases to find all published therapeutic trials of suture repair versus mesh repair technique in large hiatal hernia.Only clinical studies of levels I evidence were included.The primary outcome was hernia recurrence rate.

Results

5 clinical trials of 465 large hiatal hernia repair patients were included in the meta-analysis.The pooled overall analysis showed an approximately 2.5-fold to 4-fold increased risk of recurrence in primary hiatal defect suture repair compared to mesh repair.In subgroup analysis, studies in the long-term(>6 months)group showed that the OR was 0.48(95% CI, 0.22 to 1.01, P=0.05). The majority of the trials had at least one serious bias in study design.

Conclusion

Mesh-reinforced hiatal hernia repair is associated with an approximately 2.5-fold to 4-fold decreased risk of recurrence in comparison with simple repair.The long-term results of mesh-augmented hiatal closure remain to be further investigated after more qualified long-term RCTs emerge in future.

图1 入选Meta分析的研究选取流程图
表1 入选Meta分析的对照试验
表2 纳入研究特征及手术干预情况
表3 纳入研究的结果
表4 纳入研究的偏倚风险
图2 图2A 森林图显示对比传统缝合与补片修补的复发率危险比(包括Oelschlager等人的短期随访研究) 图2B 森林图显示对比传统缝合与补片修补的复发率危险比(包括Oelschlager等人的长期随访研究)
图3 森林图显示对比传统缝合与补片修补的复发率危险比(除外Frantzides等的研究后)
图4 森林图显示对比传统缝合与补片修补的复发率危险比(上表为长期随访组,下表为短期随访组)
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