內(nèi)鏡與開放組織結(jié)構(gòu)分離技術(shù):近期療效比較的Meta分析
發(fā)布時間：2018-10-24 18:38
【摘要】：目的:系統(tǒng)評價開放與內(nèi)鏡下組織結(jié)構(gòu)分離技術(shù)的近期療效.方法:通過互聯(lián)網(wǎng)檢索Pub Med、Spinger Link、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,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,提取相關(guān)資料,采用REVMAN5.2軟件進行meta分析。結(jié)果:經(jīng)過計算機檢索初檢出相關(guān)文獻共838篇,其中中文文獻115篇,英文文獻723篇。剔除動物實驗、重復(fù)發(fā)表及明顯不符合納入標(biāo)準(zhǔn)的初檢文獻,經(jīng)過閱讀文題和摘要初篩后納入323篇文獻。再經(jīng)過標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)嚴(yán)格篩選,最終共納入64篇文獻,8篇為對照研究文獻,56篇為病例研究文獻,其中包括7篇英文文獻和1篇中文文獻,共有408例患者,其中CST組193例,ECST組215例。56篇病例研究結(jié)果顯示:術(shù)后的并發(fā)癥內(nèi)鏡組少于開放組。Meta分析結(jié)果顯示:術(shù)后住院時間:MD=0.20,95%CI=[-0.54,0.13],P=0.23。認(rèn)為兩種手術(shù)方式在手術(shù)時間的差異無統(tǒng)計學(xué)意義。術(shù)后復(fù)發(fā)率:MD=0.6,95%CI=[0.29,1.46],P=0.30。認(rèn)為兩種手術(shù)方式在復(fù)發(fā)率的差異無統(tǒng)計學(xué),術(shù)后并發(fā)癥包括傷口感染率OR=0,95%CI=[0.050.04],P=0.91、認(rèn)為兩種手術(shù)方式在傷口感染率的差異無統(tǒng)計學(xué)意義。傷口膿腫形成率OR=-0.01,95%CI=[-0.06,-0.04],P=0.61.認(rèn)為兩種手術(shù)方式在傷口膿腫形成率的差異無統(tǒng)計學(xué)意義。傷口血清/血清腫發(fā)生率OR=0.63,95%CI=[0.29,1.38],P=0.25,認(rèn)為兩種手術(shù)方式在傷口血清/血清腫發(fā)生率的差異無統(tǒng)計學(xué)意義。手術(shù)時間:MD=29.67,95%CI=[6.93,52.42],P=0.01。兩種手術(shù)方式在手術(shù)時間的差異有統(tǒng)計學(xué)意義。術(shù)后傷口皮膚裂開率OR=0.35,95%CI=[0.16,0.78],P=0.01認(rèn)為兩種手術(shù)方式在皮膚裂開率的差異有統(tǒng)計學(xué)意義。組織壞死清創(chuàng)率OR=0.02,95%CI=[0.08,-0.45],P=0.0002,認(rèn)為兩種手術(shù)方式在皮膚裂開率的差異有統(tǒng)計學(xué)意義。結(jié)論:從MATA分析ECST與CST相比:ECST手術(shù)時間比CST短,ECST可減少術(shù)后并發(fā)癥包括傷口皮膚裂開率、傷口血清/血清腫發(fā)生率,然而在手術(shù)時間、住院時間、術(shù)后復(fù)發(fā)、術(shù)后傷口感染率、傷口膿腫形成率、傷口血清/血清腫發(fā)生率上無統(tǒng)計學(xué)差異。56篇病例研究分析得到,ECST術(shù)后并發(fā)癥少于CST組。因此臨床上對于不同的患者,應(yīng)嚴(yán)格術(shù)前評估而采取個體化的治療�？紤]所納入文獻質(zhì)量不同,仍需大樣本隨機對照研究提供證據(jù)。
[Abstract]:Objective: to evaluate the short-term efficacy of open and endoscopic tissue structure separation. Methods: the databases of Pub Med,Spinger Link,Cochrance Library,Embase,Web of Science, Wanfang, Weipu and Chinatown were searched on the Internet in Chinese and English. The two evaluators selected the documents according to the inclusion criteria and exclusion criteria, and extracted the relevant data. Meta analysis was carried out with REVMAN5.2 software. Results: a total of 838 literatures were initially identified by computer retrieval, 115 of which were in Chinese and 723 in English. The original literature which was published repeatedly and obviously did not meet the inclusion criteria was excluded from animal experiments and 323 articles were included after preliminary screening of reading questions and abstracts. After strict selection of criteria and exclusion criteria, 64 articles were included, 8 were controlled studies, 56 were case studies, including 7 English and 1 Chinese. 408 patients were included in the study. There were 193 cases in CST group and 215 cases in ECST group. The results of 56 cases showed that the postoperative complications in endoscopic group were less than those in open group. Meta analysis showed that the postoperative hospitalization time was MD=0.20,95%CI= [-0.54 鹵0.13], and the postoperative complication was 0.23. It was concluded that there was no significant difference in the operative time between the two types of operation. Postoperative recurrence rate: MD=0.6,95%CI= [0.29 鹵1.46], P < 0.30. The results showed that there was no significant difference in the recurrence rate between the two surgical methods. The postoperative complications included wound infection rate (OR=0,95%CI=) [0.050.04], P0. 91. It was concluded that there was no significant difference between the two surgical methods in wound infection rate. The rate of formation of wound abscess was OR=-0.01,95%CI= [- 0.06- 0.04], P0. 61. It was concluded that there was no significant difference in the rate of wound abscess formation between the two surgical methods. The incidence rate of serum / serum swelling in wound [0.29 1.38], P < 0.25, it was concluded that there was no significant difference between the two surgical methods in the incidence of serum / serum swelling in the wound. Time of operation: MD=29.67,95%CI= [6.93% 52.42], P < 0.01. The difference of operation time between two kinds of operation methods was statistically significant. The wound skin rupture rate (OR=0.35,95%CI=) was 0.160.78, and the difference between the two surgical methods was statistically significant. The debridement rate of tissue necrosis (OR=0.02,95%CI=) [0.08- 0.45] and the rate of tissue necrosis debridement were 0.0002. It was concluded that the difference between the two surgical methods in the rate of skin rupture was statistically significant. Conclusion: compared with CST, ECST has shorter operation time than CST. ECST can reduce the rate of postoperative complications, such as the rate of wound skin rupture, the incidence of serum / serum swelling. However, in the operation time, hospital stay, postoperative recurrence and postoperative wound infection rate, ECST can reduce the incidence of postoperative complications. There was no significant difference in the rate of wound abscess and the incidence of serum / serum swelling in the wound. 56 cases were studied and analyzed. The complications after ECST were less than those in CST group. Therefore, individualized treatment should be applied to different patients before operation. Considering the different quality of literature included, large-sample randomized controlled studies are still needed to provide evidence.
【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
本文編號：2292221
[Abstract]:Objective: to evaluate the short-term efficacy of open and endoscopic tissue structure separation. Methods: the databases of Pub Med,Spinger Link,Cochrance Library,Embase,Web of Science, Wanfang, Weipu and Chinatown were searched on the Internet in Chinese and English. The two evaluators selected the documents according to the inclusion criteria and exclusion criteria, and extracted the relevant data. Meta analysis was carried out with REVMAN5.2 software. Results: a total of 838 literatures were initially identified by computer retrieval, 115 of which were in Chinese and 723 in English. The original literature which was published repeatedly and obviously did not meet the inclusion criteria was excluded from animal experiments and 323 articles were included after preliminary screening of reading questions and abstracts. After strict selection of criteria and exclusion criteria, 64 articles were included, 8 were controlled studies, 56 were case studies, including 7 English and 1 Chinese. 408 patients were included in the study. There were 193 cases in CST group and 215 cases in ECST group. The results of 56 cases showed that the postoperative complications in endoscopic group were less than those in open group. Meta analysis showed that the postoperative hospitalization time was MD=0.20,95%CI= [-0.54 鹵0.13], and the postoperative complication was 0.23. It was concluded that there was no significant difference in the operative time between the two types of operation. Postoperative recurrence rate: MD=0.6,95%CI= [0.29 鹵1.46], P < 0.30. The results showed that there was no significant difference in the recurrence rate between the two surgical methods. The postoperative complications included wound infection rate (OR=0,95%CI=) [0.050.04], P0. 91. It was concluded that there was no significant difference between the two surgical methods in wound infection rate. The rate of formation of wound abscess was OR=-0.01,95%CI= [- 0.06- 0.04], P0. 61. It was concluded that there was no significant difference in the rate of wound abscess formation between the two surgical methods. The incidence rate of serum / serum swelling in wound [0.29 1.38], P < 0.25, it was concluded that there was no significant difference between the two surgical methods in the incidence of serum / serum swelling in the wound. Time of operation: MD=29.67,95%CI= [6.93% 52.42], P < 0.01. The difference of operation time between two kinds of operation methods was statistically significant. The wound skin rupture rate (OR=0.35,95%CI=) was 0.160.78, and the difference between the two surgical methods was statistically significant. The debridement rate of tissue necrosis (OR=0.02,95%CI=) [0.08- 0.45] and the rate of tissue necrosis debridement were 0.0002. It was concluded that the difference between the two surgical methods in the rate of skin rupture was statistically significant. Conclusion: compared with CST, ECST has shorter operation time than CST. ECST can reduce the rate of postoperative complications, such as the rate of wound skin rupture, the incidence of serum / serum swelling. However, in the operation time, hospital stay, postoperative recurrence and postoperative wound infection rate, ECST can reduce the incidence of postoperative complications. There was no significant difference in the rate of wound abscess and the incidence of serum / serum swelling in the wound. 56 cases were studied and analyzed. The complications after ECST were less than those in CST group. Therefore, individualized treatment should be applied to different patients before operation. Considering the different quality of literature included, large-sample randomized controlled studies are still needed to provide evidence.
【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
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