目的:通過對胰十二指腸切除術(shù)中胰空腸吻合的導(dǎo)管對粘膜吻合法與套入式吻合法的術(shù)后胰漏發(fā)生率、并發(fā)癥發(fā)生率、病死率等相關(guān)指標(biāo)進(jìn)行Meta分析,評價兩種吻合方式的優(yōu)劣。方法:通過計(jì)算機(jī)檢索PubMed、Cochrane Library、EMbase等數(shù)據(jù)庫自建庫以來到2018年3月份的所有涉及到胰十二指腸術(shù)中比較粘膜對導(dǎo)管吻合法和套入式吻合法的臨床研究。采用RevMan 5.3軟件對兩種術(shù)式術(shù)后胰漏發(fā)生率、重癥胰漏發(fā)生率、術(shù)后并發(fā)癥發(fā)生率、嚴(yán)重并發(fā)癥發(fā)生率、術(shù)后死亡率、再次手術(shù)率、術(shù)后住院時間等相關(guān)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:在檢索的所有文獻(xiàn)中共有9篇文獻(xiàn)符合納入標(biāo)準(zhǔn),共計(jì)1219例患者納入分析。Meta分析結(jié)果表明套入式吻合法在術(shù)后減少重癥胰漏發(fā)生率、嚴(yán)重并發(fā)癥發(fā)生率上更具有優(yōu)勢,但無明顯統(tǒng)計(jì)學(xué)差異。而在術(shù)后胰漏發(fā)生率、術(shù)后并發(fā)癥發(fā)生率、術(shù)后死亡率、再次手術(shù)率、術(shù)后住院時間套入式吻合法與導(dǎo)管對粘膜吻合法效果相當(dāng)。結(jié)論:根據(jù)現(xiàn)有的證據(jù)尚不能證明套入式吻合相對于導(dǎo)管對粘膜吻合法具有明顯的優(yōu)勢。 

【文章來源】：重慶醫(yī)科大學(xué)重慶市

【文章頁數(shù)】：40 頁

【學(xué)位級別】：碩士

【部分圖文】：

不同胰漏定義的兩組吻合方式術(shù)后胰漏發(fā)生率比較森林圖Figure4Forestplotofsubgroupsbetweendifferentdefinitionofpancreaticfistulaforthetwo

重慶醫(yī)科大學(xué)碩士研究生學(xué)位論文吻合法在總體 PF 的發(fā)生率上也無明差異（OR = 0.64，95% CI: 0.30～ 1.36，P =0.25），見圖 3，4。圖5.兩組吻合方式術(shù)后重癥胰漏發(fā)生率比較森林圖Figure 5 Forest plot of clinical relevant pancreatic fistula between the two groups

【參考文獻(xiàn)】：
期刊論文
[1]Experimental study on operative methods of pancreaticojejunostomy with reference to anastomotic patency and postoperative pancreatic exocrine function[J]. Ming-Dong Bai, Liang-Qun Rong, Lian-Chen Wang, Hai Xu, Rui-Fang Fan, Pei Wang, Xiao-Peng Chen, Liu-Bin Shi, Shu-You Peng Department of General Surgery, The Second Affiliated Hospital, Xuzhou Medical College, Xuzhou 221006, Jiangsu Province, China Department of Hepatobiliary Surgery, Lanzhou General Hospital, Lanzhou Command, PLA, Lanzhou 730050, Gansu Province, China Second Department of Health Care, Lanzhou General Hospital, Lanzhou Command, PLA, Lanzhou 730050, Gansu Province, China Department of General Surgery, Affiliated Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui Province, China Department of General Surgery, Affiliated Huashan Hospital, College of Medicine, Fudan University, Shanghai 200433, China Department of General Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.  World Journal of Gastroenterology. 2008(03)



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