發(fā)布時(shí)間：2018-11-25 12:47

【摘要】：目的:系統(tǒng)評(píng)價(jià)腹腔鏡與開腹消化性潰瘍穿孔修補(bǔ)術(shù)的安全性以及有效性。方法:收集1980年1月-2014年9月的已經(jīng)發(fā)表的有關(guān)腹腔鏡與開腹修補(bǔ)消化性潰瘍穿孔的療效的比較的中文和英文文獻(xiàn),中文文獻(xiàn)(萬(wàn)方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)、中國(guó)知網(wǎng)),英文文獻(xiàn)(ochrane Library,Pub Med,Embase)。英文檢索腹腔鏡AND(開腹OR開放)AND潰瘍穿孔修補(bǔ)。根據(jù)文獻(xiàn)的納入排除標(biāo)準(zhǔn),由兩名研究生分別單獨(dú)對(duì)符合條件的文獻(xiàn)進(jìn)行相關(guān)資料的輸出,如果有不同的意見(jiàn)進(jìn)行討論解決。使用Rev Man 5.2.7版本軟件對(duì)輸出的資料進(jìn)行meta分析;利用Rev Man 5.2.7軟件完成異質(zhì)性分析檢驗(yàn),根據(jù)異質(zhì)性的結(jié)果選擇固定或者隨機(jī)效應(yīng)模型。發(fā)表偏倚用漏斗圖來(lái)表示。結(jié)果:符合本研究條件的共有6篇隨機(jī)對(duì)照試驗(yàn),共計(jì)682例患者,其中腹腔鏡組有362例,開腹組有320例。Meta分析結(jié)果顯示,腹腔鏡與開腹消化性潰瘍穿孔修補(bǔ)術(shù)比較,腹腔鏡手術(shù)組術(shù)中出血量較少(P0.00001);腸蠕動(dòng)恢復(fù)時(shí)間較短(P=0.002);住院時(shí)間縮短(P0.00001);術(shù)后主要并發(fā)癥如切口感染(P0.00001)、肺部感染(P=0.04)、術(shù)后腸梗阻(P=0.03)發(fā)生率減少,而在手術(shù)時(shí)間(P=0.37)、腹腔膿腫(P=0.57)、術(shù)后死亡率(P=0.34)方面,腹腔鏡組與開腹組之間的差異并無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:腹腔鏡手術(shù)治療消化性潰瘍穿孔與開腹手術(shù)相比,出血較少、打擊小、術(shù)后恢復(fù)更加迅速、術(shù)后主要并發(fā)癥發(fā)生率也較低,是一種安全可行的治療手段。
[Abstract]:Objective: to evaluate the safety and efficacy of laparoscopic and open peptic ulcer perforation repair. Methods: from January 1980 to September 2014, Chinese and English literatures on the efficacy of laparoscopic and open repair of peptic ulcer perforation were collected. English literature (ochrane Library,Pub Med,Embase). To search laparoscopic AND (open OR open) AND ulcer perforation repair. According to the inclusion and exclusion criteria of the literature, two graduate students separately carry on the relevant data output to the qualified documents, if there are different opinions to discuss and solve. The outputted data are analyzed by meta using Rev Man version 5.2.7 software, and the heterogeneity analysis test is completed by Rev Man 5.2.7 software. According to the results of heterogeneity, fixed or random effect models are selected. Publication bias is represented by funnel diagrams. Results: a total of 6 randomized controlled trials were conducted, including 362 cases in the laparoscopic group and 320 cases in the open group. Meta analysis showed that laparoscopic repair of peptic ulcer perforation was compared with laparoscopy. The amount of intraoperative bleeding was less in the laparoscopic operation group (P0.00001). The recovery time of intestinal peristalsis was shorter (P0. 002), the hospitalization time was shorter (P0. 00001). The main postoperative complications such as incision infection (P0.00001), pulmonary infection (P0. 04), postoperative intestinal obstruction (P0. 03) were decreased, but at the time of operation (P0. 37), abdominal abscess (P0. 57). There was no significant difference in postoperative mortality (P < 0. 34) between laparoscopy group and open group. Conclusion: laparoscopic surgery for peptic ulcer perforation is a safe and feasible method for the treatment of peptic ulcer perforation with less bleeding, less attack, faster postoperative recovery and lower incidence of major postoperative complications.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R656.62

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本文編號(hào)：2356158