發(fā)布時(shí)間：2018-06-28 04:51

  本文選題：皮膚軟組織擴(kuò)張術(shù) + 修復(fù)重建��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景:皮膚軟組織擴(kuò)張術(shù)是利用擴(kuò)張器對(duì)皮膚軟組織進(jìn)行擴(kuò)張,產(chǎn)生“額外”組織用于體表各部位缺損的修復(fù)重建。皮膚軟組織擴(kuò)張術(shù)發(fā)明至今已經(jīng)歷了 40余年的發(fā)展,隨著擴(kuò)張技術(shù)的變革、皮瓣血管解剖認(rèn)識(shí)的加深、影像學(xué)技術(shù)的介入、干細(xì)胞移植技術(shù)的引入,擴(kuò)張皮瓣朝向更大、更薄的方向發(fā)展,臨床應(yīng)用范圍也隨之?dāng)U大,現(xiàn)已用于全身各部位皮膚軟組織缺損的修復(fù),目前已成為整形外科的常規(guī)修復(fù)重建方法。但皮膚軟組織擴(kuò)張術(shù)具有治療周期長(zhǎng)、治療經(jīng)費(fèi)開(kāi)銷(xiāo)大、相關(guān)并發(fā)癥發(fā)生率較高等不足之處。常見(jiàn)并發(fā)癥有感染、血腫、切口開(kāi)裂、皮膚壞死等。并發(fā)癥的不良預(yù)后阻礙了擴(kuò)張器進(jìn)一步的發(fā)展與應(yīng)用,尤其是感染并發(fā)癥對(duì)最終皮膚修復(fù)成功與否有極大影響。目前,對(duì)皮膚軟組織擴(kuò)張器感染并發(fā)癥的相關(guān)危險(xiǎn)因素進(jìn)行meta分析尚未見(jiàn)報(bào)道。目的:本研究旨在通過(guò)meta分析,合并既往研究結(jié)果數(shù)據(jù),通過(guò)較大樣本量來(lái)驗(yàn)證與皮膚軟組織擴(kuò)張器感染密切相關(guān)的危險(xiǎn)因素,為一線工作的臨床醫(yī)師提供參考數(shù)據(jù)以及一級(jí)預(yù)防的相關(guān)資料,盡可能降低感染的發(fā)生率,進(jìn)而提高治療效果。資料與方法:通過(guò)對(duì)Pubmed、Cochrane Library、Embase、中國(guó)知網(wǎng)以及萬(wàn)方醫(yī)學(xué)網(wǎng)數(shù)據(jù)庫(kù)進(jìn)行文獻(xiàn)檢索,對(duì)從1986年至2016年已發(fā)表的相關(guān)文獻(xiàn)進(jìn)行歸納整理。按照一定的納入、排除標(biāo)準(zhǔn),選擇符合要求的文獻(xiàn),采用meta分析進(jìn)行定量分析,分析皮膚軟組織擴(kuò)張器感染的相關(guān)危險(xiǎn)因素。結(jié)果:最終納入17篇1992-2006年間發(fā)表的回顧性觀察性研究,其中包含8280例患者。對(duì)所選文獻(xiàn)中軟組織擴(kuò)張器感染相關(guān)危險(xiǎn)因素進(jìn)行分析。擴(kuò)張器埋置部位(四肢)、局部瘢痕、注水閥門(mén)外置、吸煙、肥胖、糖尿病、放療相對(duì)危險(xiǎn)比可信區(qū)間大于1,具有統(tǒng)計(jì)學(xué)意義。提示這些因素與皮膚軟組織擴(kuò)張器感染發(fā)生存在明顯的相關(guān)性。結(jié)論:擴(kuò)張器埋置部位(四肢)、局部瘢痕、注水閥門(mén)外置、吸煙、肥胖、糖尿病、放療等危險(xiǎn)因素可能增加皮膚軟組織擴(kuò)張器感染的發(fā)生。本系統(tǒng)回顧研究與薈萃分析為臨床工作的一線醫(yī)師提供了關(guān)于皮膚軟組織擴(kuò)張器感染的相關(guān)危險(xiǎn)因素的有利證據(jù)。
[Abstract]:Background: skin and soft tissue dilatation is the use of dilator to expand the skin and soft tissue, resulting in "extra" tissue for the repair and reconstruction of defects in various parts of the body surface. The development of skin and soft tissue expansion has gone through more than 40 years. With the development of expansion technique, the understanding of vascular anatomy of skin flap, the intervention of imaging technology, the introduction of stem cell transplantation, the expansion of skin flap towards a larger direction. With the development of thinning, clinical application has been expanded, which has been used to repair skin and soft tissue defects in various parts of the body, and has become the conventional method of plastic surgery. However, skin and soft tissue dilatation has many disadvantages, such as long treatment cycle, high cost and high incidence of complications. Common complications include infection, hematoma, incision cracking, skin necrosis and so on. The poor prognosis of complications hinders the further development and application of dilators, especially the infection complications have a great impact on the success of the final skin repair. At present, meta analysis of risk factors related to complications of skin and soft tissue dilator infection has not been reported. Objective: to investigate the risk factors associated with skin and soft tissue dilatator infection by meta analysis and data from previous studies. In order to reduce the incidence of infection and improve the therapeutic effect, the reference data and the related data of primary prevention are provided for the clinicians working on the first line. Materials and methods: through the literature retrieval of Pubmedan Cochrane Library Embase, China knowledge Network and Wanfang Medical Network, the relevant literatures published from 1986 to 2016 were summarized and sorted out. According to certain inclusion, exclusion criteria, selected documents that meet the requirements, meta analysis was used for quantitative analysis to analyze the risk factors of skin and soft tissue dilator infection. Results: 17 retrospective observational studies published between 1992 and 2006 were included, including 8280 patients. The risk factors associated with soft tissue dilator infection in selected literature were analyzed. The relative risk of dilatator (limb), local scar, water injection valve, smoking, obesity, diabetes, and radiotherapy were higher than 1, which was statistically significant. These results suggest that there is a significant correlation between these factors and the occurrence of skin soft tissue dilator infection. Conclusion: the risk factors of dilator implantation (limb), local scar, water injection valve placement, smoking, obesity, diabetes, radiotherapy and other risk factors may increase the occurrence of skin and soft tissue dilator infection. This systematic retrospective study and meta-analysis provide clinical first-line physicians with useful evidence on the risk factors associated with skin and soft tissue dilatator infection.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R622

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本文編號(hào)：2076811