本文選題：全結(jié)腸切除 + 腹腔鏡手術(shù)�。� 參考：《青海大學(xué)》2015年碩士論文

【摘要】：目的:通過Meta分析對腹腔鏡與傳統(tǒng)開腹全結(jié)腸切除術(shù)治療全結(jié)腸疾病的安全性進(jìn)行綜合評價。方法:檢索Pub Med、Cochrance Library、Embase、Web of Science、萬方、維普、中國知網(wǎng)等數(shù)據(jù)庫,語種為中英文文獻(xiàn),兩名評價員根據(jù)納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn)選擇文獻(xiàn),提取相關(guān)資料,采用REVMAN 5.2軟件進(jìn)行meta分析。結(jié)果:最終獲得文獻(xiàn)6篇(226例),其中1篇為隨機(jī)對照試驗。Meta分析結(jié)果顯示:手術(shù)時間:SMD=49.93,CI=[-26.8,126.45],P=0.20,兩種手術(shù)方式在手術(shù)時間的差異無統(tǒng)計學(xué)意義。術(shù)中估計出血量:SMD=-0.41,CI=[-0.68,-0.14],P=0.003。兩種手術(shù)方式在術(shù)中出血量的差異有統(tǒng)計學(xué)意義。術(shù)后胃腸道功能恢復(fù)時間:SMD=-1.11,95%CI=[-1.72,-0.50],P0.0003。兩種手術(shù)方式在胃腸道功能恢復(fù)時間上的差異具有統(tǒng)計學(xué)意義。術(shù)后住院時間:MD=-5.73,95%CI=[-5.99,-4.75],P0.00001,差異具有統(tǒng)計學(xué)意義。吻合口瘺發(fā)生率:OR=0.49,95%CI=[0.17,1.43],P=0.19。術(shù)后吻合口瘺發(fā)生的差異無統(tǒng)計學(xué)意義。腸梗阻發(fā)生的比較:OR=0.40,95%CI=[0.16,1.00],P=0.05,差異無統(tǒng)計學(xué)意義。切口感染:OR=0.53,95%CI=[0.22,1.31],P=0.17,差異無統(tǒng)計學(xué)意義。切口長度:MD=-10.68,95%CI=[-10.95,-10.41],P0.00001,差異有統(tǒng)計學(xué)意義。結(jié)論:腹腔鏡全結(jié)腸切除在手術(shù)時間、切口感染、腸梗阻發(fā)生率、吻合口瘺發(fā)生率上無統(tǒng)計學(xué)差異,但可減少術(shù)中出血、縮短手術(shù)切口,縮短胃腸道功能恢復(fù)時間,從而減少術(shù)后住院時間。因此在臨床上對于不同情況的患者,應(yīng)按照循證醫(yī)學(xué)思維模式,嚴(yán)格術(shù)前評估而采取個體化的治療。考慮所納入文獻(xiàn)質(zhì)量不同,仍需大樣本隨機(jī)對照研究提供更加充足的臨床指導(dǎo)證據(jù)。
[Abstract]:Objective: to evaluate the safety of laparoscopic and traditional open colectomy in the treatment of total colonic diseases by Meta analysis. Methods: the Pub Medrance Cochrance Library Embase Web of Science, Wanfang, Weipu and ChinaNet databases in Chinese and English were searched. According to the inclusion criteria and exclusion criteria, two evaluators selected the literature and extracted the relevant data. Meta analysis was carried out with REVMAN 5.2 software. Results: a total of 226 cases with 6 references were obtained, of which 1 was a randomized controlled trial. Meta-analysis showed that the operative time was 49.93 CI = [-26.8126.45], and there was no significant difference between the two operative methods in the operation time. The intraoperative blood loss was estimated to be 0.41% SMD-0.41% CI = [-0.68 鹵0.14] P0. 003. There was a significant difference in the amount of intraoperative bleeding between the two types of operation. The recovery time of gastrointestinal function after operation was: SMD-1.1195 CI = [-1.72 鹵0.50] P 0.0003. There was significant difference in the recovery time of gastrointestinal function between the two surgical methods. The postoperative hospitalization time was 1: 00 MDN -5.73N 95 CI = [-5.99 鹵-4.75] P 0.00001, the difference was statistically significant. The incidence of anastomotic leakage was 0.49% (CI = 0.171.43) and 0.19% (P < 0.05). There was no significant difference in the occurrence of anastomotic leakage after operation. There was no significant difference in the incidence of intestinal obstruction (CI = [0.161.00] P0. 05). There was no significant difference in wound infection between 0.53% and 95% (CI = [0.22 鹵1.31]) (P = 0.17). The incision length: MD-10.68C95% CI = [-10.95U -10.41] P0.00001, the difference was statistically significant. Conclusion: laparoscopic total colectomy has no significant difference in operative time, incision infection, intestinal obstruction and anastomotic leakage, but it can reduce intraoperative bleeding, shorten operative incision and shorten gastrointestinal function recovery time. So as to reduce postoperative hospital stay. Therefore, individualized treatment should be taken according to the thinking mode of evidence-based medicine and strict preoperative evaluation for patients with different clinical conditions. Considering the different quality of literature included, it is still necessary to provide more sufficient clinical guidance evidence in large sample randomized controlled trials.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.9

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