本文關(guān)鍵詞： 膽總管結(jié)石 腹腔鏡 膽道鏡 開腹手術(shù)　出處：《山西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較腹腔鏡聯(lián)合膽道鏡膽總管切開取石術(shù)與開腹手術(shù)在膽總管結(jié)石治療方面的臨床療效和安全性。方法:計算機(jī)檢索CBMdisc、CNKI、Wan Fang Data、VIP,使用“膽總管結(jié)石”、“腹腔鏡”、“膽道鏡”、“開腹手術(shù)”等檢索詞進(jìn)行關(guān)鍵詞檢索;以“common bile duct calculi”、“open surgery”、“l(fā)aparoscopic common bile duct exploration”、“choledochoscopy”為檢索詞檢索Pub Med、Cochrane Library、EMBASE。檢索從各建庫時間到2014年12月。手工檢索已經(jīng)發(fā)表的關(guān)于腹腔鏡聯(lián)合膽道鏡與開腹手術(shù)比較治療膽總管結(jié)石的國內(nèi)外文獻(xiàn),并追查相關(guān)納入文獻(xiàn)的參考文獻(xiàn),使用Revman 5.0軟件完成相關(guān)手術(shù)指標(biāo)的Meta分析,采用比值比(OR值),加權(quán)均數(shù)差(WMD)和95%置信區(qū)間(95%CI)進(jìn)行療效的評價,最后對分析結(jié)果進(jìn)行整理并發(fā)表。結(jié)果:此次納入Meta分析的文獻(xiàn)共21篇,其中,中文17篇,英文4篇,共2600例患者。Meta分析結(jié)果顯示:腹腔鏡聯(lián)合膽道鏡治療膽總管結(jié)石的療效優(yōu)于開腹手術(shù)。在手術(shù)時間方面,腹腔鏡聯(lián)合膽道鏡組長于開腹手術(shù)組,WMD值等于6.27,95%的置信區(qū)間為(4.81,7.73),P㩳0.05。在術(shù)中出血量方面,腹腔鏡聯(lián)合膽道鏡組少于開腹手術(shù)組,WMD值等于-109.82,95%的置信區(qū)間為(-112.26,-107.39),P㩳0.05。雙鏡組在術(shù)后下床活動時間上優(yōu)于開腹組,WMD值等于-34.56,95%的置信區(qū)間為(-38.89,-30.24),P㩳0.05。雙鏡組在術(shù)后首次排氣時間上優(yōu)于開腹組,WMD值等于-37.54,95%的置信區(qū)間為(-38.11,-36.98),P㩳0.05。手術(shù)總并發(fā)癥發(fā)生率OR值0.24,95%的置信區(qū)間(0.17,0.35),雙鏡組優(yōu)于開腹組。使用止痛劑情況OR值0.13,95%的置信區(qū)間(0.10,0.18),雙鏡組優(yōu)于開腹組。在結(jié)石殘余率方面,雙鏡組和開腹組的差異無統(tǒng)計學(xué)意義。結(jié)論:在術(shù)中失血量、術(shù)后下床活動時間、術(shù)后住院時間、術(shù)后首次排氣時間、使用止痛劑、并發(fā)癥發(fā)生率,雙鏡組都優(yōu)于開腹手術(shù)組。在手術(shù)時間方面,開腹組優(yōu)于雙鏡組。結(jié)石殘余率方面,兩組差異無統(tǒng)計學(xué)意義。
[Abstract]:Objective: to compare the clinical efficacy and safety of laparoscopic choledocholithotomy combined with laparoscopic choledocholithotomy in the treatment of choledocholithiasis. "choledochoscope", "open surgery" and other key words for keyword retrieval; "common bile duct calculi", "open surgery", "laparoscopic common bile duct exploration" and "choledochoscopy" were used to search Pub Meda Cochrane Library EMBASE.Retrieval of published literatures on the comparison of laparoscopic choledochoscopy and open choledocholithiasis for common bile duct calculi was carried out manually from December 2014 to December 2014. The related references were followed up, and the Meta analysis of the related surgical indexes was completed by using Revman 5.0 software. The therapeutic effect was evaluated by the ratio ratio ratio or value, the weighted mean difference (WMD) and the 95% confidence interval (95 CI). Results: there were 21 articles including 17 in Chinese and 4 in English, which were included in the Meta analysis. Meta-analysis of 2600 patients showed that laparoscopic combined choledochoscopy was more effective than open surgery in the treatment of choledocholithiasis. In terms of intraoperative bleeding volume, the confidence interval of WMD value of laparoscopy combined with choledochoscope group was less than that of open operation group (-109.82 鹵95%). The confidence interval of Laparoscopic combined choledochoscope group was -112.26 ~ 107.39? The results showed that the WMD of the double mirror group was better than that of the open group in the time of getting out of bed. The confidence interval of WMD equal to -34.56% was -38.89% -30.24% P? The confidence interval of WMD equal to -37.54-95% in the double-mirror group was -38.11 ~ 36.98 ~ (-36.98), which was better than that in the open group in the first time of exhaust after operation. 0. 05. The OR of the total complication rate of operation is 0.24 95% confidence interval 0.17 ~ 0.35%, the double mirror group is superior to the open operation group. The OR value of 0.13 ~ 95% confidence interval is 0.100.18%, the double mirror group is better than the open operation group, and the residual rate of stone is better in the double mirror group than in the laparotomy group, in the case of analgesic agent, the OR value of 0.1395% confidence interval is 0.100.18%. There was no significant difference between the two groups. Conclusion: the blood loss during operation, the time of getting out of bed after operation, the time of hospitalization, the time of first exhaust after operation, the use of analgesics, the incidence of complications, In the operation time, the open group was better than the double mirror group. The residual rate of stone in the two groups had no statistical significance.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.42

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 崔賓;閆平釗;王建華;;腹腔鏡聯(lián)合膽道鏡與開腹治療膽囊膽總管結(jié)石82例[J];臨床醫(yī)學(xué);2011年07期

2 趙普;莫耀良;唐傳軍;黃國增;黃基正;蔣京育;;腹腔鏡、膽道鏡聯(lián)合治療膽總管結(jié)石的臨床研究[J];腹腔鏡外科雜志;2007年04期

3 陳駿;居來提;于亮;楊東鷹;段紹斌;;腹腔鏡膽道鏡膽總管探查取石術(shù)與開腹手術(shù)臨床療效比較[J];腹腔鏡外科雜志;2010年07期

4 賀偉;張小文;朱紅;李越華;王琨;;開腹與腹腔鏡治療膽總管結(jié)石的臨床對比研究[J];中國現(xiàn)代普通外科進(jìn)展;2012年03期

5 李其煥;王群偉;;腹腔鏡聯(lián)合纖維膽道鏡治療膽囊結(jié)石合并膽總管結(jié)石172例臨床分析[J];中國現(xiàn)代手術(shù)學(xué)雜志;2010年02期

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