發(fā)布時(shí)間：2018-04-16 00:25

  本文選題：皮膚軟組織擴(kuò)張 + 瘢痕　； 參考：《吉林大學(xué)》2016年碩士論文

【摘要】：目的:皮膚軟組織擴(kuò)張術(shù)在臨床整形修復(fù)外科中的應(yīng)用,對于美容修復(fù)、皮膚軟組織重建等均產(chǎn)生了巨大影響,皮膚軟組織擴(kuò)張器植入能提供較多高質(zhì)量的額外皮膚,是一種高效、實(shí)用且更接近美學(xué)標(biāo)準(zhǔn)的組織修復(fù)方法。目前國內(nèi)外相關(guān)研究較多,但相對樣本均較小,本研究通過Meta分析來對比研究皮膚軟組織擴(kuò)張術(shù)與傳統(tǒng)的復(fù)合皮移植術(shù)在治療燒傷后瘢痕的有效性、安全性方面的差異,從而得到更客觀和可靠的研究結(jié)果,以期為臨床醫(yī)生提供決策依據(jù)。方法:檢索2000年1月至2016年9月公開發(fā)表的關(guān)于皮膚軟組織擴(kuò)張術(shù)與復(fù)合皮移植術(shù)治療燒傷后瘢痕的隨機(jī)對照試驗(yàn)(RCT)或臨床對照試驗(yàn)(CCT)。檢索的數(shù)據(jù)庫包括Pub Med、EMBASE、CNKI、維普和萬方數(shù)據(jù)庫;按照制定好的納入及排除標(biāo)準(zhǔn)對檢索到的文獻(xiàn)進(jìn)行嚴(yán)格的篩選,并按照Cochrane系統(tǒng)評價(jià)手冊對納入的文獻(xiàn)進(jìn)行風(fēng)險(xiǎn)偏倚評估;按照預(yù)先設(shè)計(jì)好的表格獨(dú)立提取數(shù)據(jù),結(jié)局指標(biāo)包括有效率、平均創(chuàng)面愈合時(shí)間、創(chuàng)面皮膚血運(yùn)恢復(fù)時(shí)間及不良反應(yīng)發(fā)生例數(shù);應(yīng)用由國際循證醫(yī)學(xué)協(xié)作組提供的Rev Man 5.1軟件對數(shù)據(jù)進(jìn)行異質(zhì)性檢驗(yàn)和合并統(tǒng)計(jì)分析,二分類變量采用比值比(OR)、連續(xù)型變量采用均數(shù)差(MD)作為合并統(tǒng)計(jì)量,根據(jù)異質(zhì)性檢驗(yàn)結(jié)果選擇相應(yīng)模型進(jìn)行合并統(tǒng)計(jì)分析;利用Rev Man 5.1進(jìn)行漏斗圖的繪制,并結(jié)合使用Stata13.0軟件對發(fā)表偏倚進(jìn)行Begg’s檢驗(yàn)以判定發(fā)表偏倚的有無。結(jié)果:(1)本Meta分析共納入16篇文獻(xiàn),均為中文;納入的16篇文獻(xiàn)中有三篇具有高風(fēng)險(xiǎn)偏倚,其余均為風(fēng)險(xiǎn)偏倚不明確;(2)報(bào)告有效率的文獻(xiàn)共16篇,異質(zhì)性檢驗(yàn)P=0.990.05,表明各研究間同質(zhì),使用固定效應(yīng)模型合并統(tǒng)計(jì)量,結(jié)果顯示,OR合并(95%CI)為6.95(4.64,10.44),皮膚軟組織擴(kuò)張術(shù)組與復(fù)合皮移植術(shù)組治療燒傷后瘢痕的有效性差異有統(tǒng)計(jì)學(xué)意義(Z=9.19,P0.01);(3)含平均創(chuàng)面愈合時(shí)間及創(chuàng)面皮膚血運(yùn)恢復(fù)時(shí)間的4篇文獻(xiàn)進(jìn)行異質(zhì)性檢驗(yàn),P=0.820.05,同質(zhì)性較好,采用固定效應(yīng)模型合并統(tǒng)計(jì)量,平均創(chuàng)面愈合時(shí)間合并結(jié)果顯示,MD合并(95%CI)為-4.2(-4.93,-3.47),皮膚軟組織擴(kuò)張組與復(fù)合皮移植組平均創(chuàng)面愈合時(shí)間差異有統(tǒng)計(jì)學(xué)意義(Z=11.32,P0.01),創(chuàng)面皮膚血運(yùn)恢復(fù)時(shí)間合并結(jié)果顯示,MD合并(95%CI)為-5.35(-6.24,-4.46),皮膚軟組織擴(kuò)張術(shù)組與對照組血運(yùn)恢復(fù)時(shí)間差異有統(tǒng)計(jì)學(xué)意義(Z=11.81,P0.01);(4)治療的安全性方面,共有12篇文獻(xiàn)報(bào)告了該指標(biāo),異質(zhì)性檢驗(yàn)發(fā)現(xiàn),P=0.980.05,同質(zhì)性較好,采用固定效應(yīng)模型合并統(tǒng)計(jì)量,OR合并(95%CI)為0.33(0.29,0.49),皮膚軟組織擴(kuò)張組的總不良反應(yīng)發(fā)生率明顯少于復(fù)合皮移植組(Z=5.74,P0.01);(5)各指標(biāo)發(fā)表偏倚結(jié)果顯示,不存在發(fā)表偏倚(P0.5);敏感性分析顯示,結(jié)果較為穩(wěn)定。結(jié)論:皮膚軟組織擴(kuò)張術(shù)治療燒傷后瘢痕有效性優(yōu)于復(fù)合皮移植術(shù),平均創(chuàng)面愈合時(shí)間及創(chuàng)面皮膚血運(yùn)恢復(fù)時(shí)間短,且不良反應(yīng)發(fā)生率較低,安全性較高,適于在燒傷后瘢痕修復(fù)中廣泛使用;本研究納入的16篇文獻(xiàn)相對質(zhì)量不高,但不存在發(fā)表偏倚且結(jié)果的穩(wěn)定性較好。
[Abstract]:Objective: the application of skin soft tissue expansion in clinical plastic repair surgery, for cosmetic restoration, both had a huge impact on skin and soft tissue reconstruction, implantation of skin soft tissue expander can provide additional skin more high quality, is an efficient and practical method of tissue repair and closer to the aesthetic standards at home and abroad. More research, but relatively small samples, this research on comparative effectiveness study of skin soft tissue expansion with the traditional composite skin graft in the treatment of burn scar by Meta analysis, different security aspects, so as to get the results more objective and reliable, in order to provide decision-making basis for clinicians. Retrieval of randomized controlled trials on skin soft tissue expansion and composite skin transplantation in the treatment of burn scar in January 2000 and published in September 2016 (RCT) or clinical controlled trial Test (CCT). Search databases including Pub Med, EMBASE, CNKI, VIP and Wanfang database; according to the inclusion and exclusion criteria of the retrieved data were strictly screened out, and according to the Cochrane evaluation system manual for assessing the risk of bias of the included literature; in accordance with the pre designed data extraction form independent outcomes included, efficiency, the average time of wound healing, wound skin blood circulation recovery time and adverse reaction cases; application by the Cochrane Collaboration with Rev Man 5.1 software for data heterogeneity test and combined statistical analysis, two categorical variables using the odds ratio (OR), with continuous variables the mean difference (MD) as a combined statistics, according to the heterogeneity test results select the corresponding model combined with statistical analysis; 5.1 funnel plots using Rev Man, and combined use of Stata13.0 software Publication bias Begg 's test to determine whether the publication bias. Results: (1) the Meta analysis of 16 articles were included, are Chinese; in 16 articles and three articles with a high risk of bias, the rest are the risk of bias is not clear; (2) reported a total efficiency 16, test for heterogeneity between the studies show that P=0.990.05, homogeneous, using a fixed effects model with statistics. The results showed that with OR (95%CI) 6.95 (4.64,10.44), skin soft tissue expansion group and composite skin graft group after treatment of burn scar is effective and there was statistically significant difference (Z=9.19, P0.01) (3); 4 articles containing the average wound healing time and the recovery time of the wound skin blood test for heterogeneity, P=0.820.05, homogeneity, using fixed effect model with statistics, the average wound healing time and the results showed that with MD (95%CI) -4.2 (-4.93, -3.47) The skin, soft tissue expansion group and composite skin transplantation group the average wound healing time was statistically significant difference (Z=11.32, P0.01), the blood supply of skin wound recovery time with results showed that with MD (95%CI) -5.35 (-6.24, -4.46), the skin soft tissue expansion group and control group blood return time difference statistical significance (Z=11.81, P0.01); (4) the safety of treatment, a total of 12 articles reported the index, heterogeneity test, P=0.980.05, homogeneity, using fixed effect model combined with statistics, OR (95% CI) 0.33 (0.29,0.49), the occurrence of skin soft tissue expansion group total the rate of adverse reactions was significantly less than the composite skin transplantation group (Z=5.74, P0.01); (5) the index of publication bias showed that there was no evidence of publication bias (P0.5); the sensitivity analysis shows that the results are more stable. Conclusion: the surgical treatment of burn scar is better than the skin soft tissue expansion Composite skin transplantation, the average wound healing time and wound skin blood circulation and recovery time is short, and low incidence rate of adverse reaction, high safety, and is suitable for wide use in burn scar repair; 16 articles were included in the study of the relative quality is not high, but there are no published results on the partial stability and better.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R644

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