【摘要】：目的:肝血管瘤是臨床實踐中常見的肝臟良性病變,由于體檢率增加和住院病人常規(guī)檢查使肝血管瘤檢出率不斷增加。手術(shù)治療是臨床醫(yī)師認可的有效治療方式,隨著技術(shù)水平的提高和腔鏡下新器械的推出,腹腔鏡微創(chuàng)技術(shù)逐漸應(yīng)用于肝血管瘤的治療,改變了現(xiàn)有的治療模式,并擴大了肝血管瘤的手術(shù)治療的適應(yīng)癥。但相對于傳統(tǒng)開腹手術(shù)而言,肝血管瘤的手術(shù)效果、安全性及應(yīng)用的必要性仍存在一定爭議。本文從循證醫(yī)學(xué)的角度應(yīng)用Meta分析的方式進行研究,首先檢索目前已發(fā)表的關(guān)于腹腔鏡手術(shù)治療對比開腹手術(shù)治療肝血管瘤的病例對照試驗,通過對比術(shù)中、術(shù)后相關(guān)臨床資料,探討腹腔鏡微創(chuàng)技術(shù)拓展應(yīng)用于肝血管瘤這一病種的臨床特征和可行性,進一步指導(dǎo)臨床手術(shù)方式的選擇。方法:應(yīng)用Cochrane圖書館、中國知網(wǎng)、維普中文科技期刊數(shù)據(jù)庫、Pub Med、Embase、萬方醫(yī)學(xué)網(wǎng)等數(shù)據(jù)庫,時間限制為各數(shù)據(jù)庫建立以來至2017年3月1日。使用數(shù)據(jù)處理軟件Rev Man5.3進行數(shù)據(jù)分析,制作相關(guān)森林圖及用于定性評價的漏斗圖,并結(jié)合臨床進行相關(guān)統(tǒng)計分析。結(jié)果:通過檢索,納入13篇文獻資料,共納入690例患者,開腹手術(shù)切除肝血管瘤例數(shù)共338例,行腹腔鏡手術(shù)切除的患者共352例。經(jīng)過軟件meta分析,腹腔鏡組在降低術(shù)中出血量、減少手術(shù)時間、縮短住院所需時間、最大限度減少術(shù)后并發(fā)癥發(fā)面優(yōu)于開腹手術(shù)治療肝血管瘤的病例,兩組在切肝時間、住院費用方面比例方面無統(tǒng)計學(xué)差異。結(jié)論:腹腔鏡手術(shù)切除可安全應(yīng)用于肝血管瘤的臨床治療,與目前傳統(tǒng)開腹手術(shù)切除相比,腹腔鏡手術(shù)切除肝血管瘤總體療效優(yōu)于開腹手術(shù),能顯著減少術(shù)中出血量、住院時間、術(shù)后并發(fā)癥發(fā)生率,手術(shù)時間,同時在住院費用及切肝時間方面兩種術(shù)式相當(dāng)。就目前病例報道而言,由于存在數(shù)量相對少、異質(zhì)性較大、發(fā)表偏移等不足,需要進一步多中心的臨床病例研究進一步驗證。
[Abstract]:Objective: hepatic hemangioma is a common benign disease of liver in clinical practice. The detection rate of hepatic hemangioma is increasing because of the increase of physical examination rate and routine examination of inpatients. Surgical treatment is an effective treatment approved by clinicians. With the improvement of technical level and the introduction of new instruments under laparoscopy, laparoscopic minimally invasive technique has gradually been applied to the treatment of hepatic hemangioma, which has changed the existing treatment mode. The indication of surgical treatment of hepatic hemangioma was expanded. However, compared with the traditional open surgery, the surgical effect, safety and the necessity of application of hepatic hemangioma are still controversial. In this paper, Meta analysis was used to study the Evidence-based Medicine (EBM). First of all, we searched the published case control trials on laparoscopic surgery and open surgery for hepatic hemangioma. To explore the clinical characteristics and feasibility of laparoscopic minimally invasive technique in the treatment of hepatic hemangioma and to further guide the selection of clinical surgical methods. Methods: the Cochrane Library, China knowledge Network, Weipu Chinese Science and Technology Journal Database, Pub Med,Embase, Wanfang Medical Network and other databases were used. The time limit was from the establishment of each database to March 1, 2017. Data processing software Rev Man5.3 was used for data analysis, and relevant forest maps and funnel charts for qualitative evaluation were made, and related statistical analysis was carried out in combination with clinical practice. Results: a total of 690 patients were included, 338 patients were resected by laparotomy and 352 patients underwent laparoscopic resection. According to the analysis of software meta, the laparoscopic group can reduce the amount of intraoperative bleeding, reduce the operation time, shorten the time needed for hospitalization, and minimize the postoperative complications, which is better than the open operation in the treatment of hepatic hemangioma, and the time of hepatectomy in the two groups is better than that in the laparotomy group. There was no statistical difference in the proportion of hospital expenses. Conclusion: laparoscopic resection can be safely used in the clinical treatment of hepatic hemangioma. Compared with traditional open surgery, laparoscopic resection of hepatic hemangioma is more effective than open surgery, and can significantly reduce the amount of intraoperative bleeding. The length of hospitalization, the incidence of postoperative complications, the time of operation, the cost of hospitalization and the time of liver resection were similar. As far as the current case reports are concerned, due to the relatively small number, large heterogeneity, publication offset and other deficiencies, further multi-center clinical case studies are needed to further verify.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7

【參考文獻】

相關(guān)期刊論文 前10條

1 劉禮軍;余偉;;對肝血管瘤實施腹腔鏡肝部分切除治療的臨床效果探討[J];中國社區(qū)醫(yī)師;2016年36期

2 宋宏偉;趙艷華;蓋鋒;;超聲引導(dǎo)下注射藥物治療肝血管瘤的臨床應(yīng)用[J];世界最新醫(yī)學(xué)信息文摘;2016年93期

3 符開伙;張劍權(quán);蔣明;;腹腔鏡下肝切除術(shù)治療肝血管瘤臨床研究[J];實用肝臟病雜志;2016年06期

4 朱榮華;胡剛峰;王華;高偉陳;;外科手術(shù)與經(jīng)導(dǎo)管動脈栓塞法治療肝血管瘤療效比較[J];現(xiàn)代儀器與醫(yī)療;2016年05期

5 李旭彤;吳寶音;李偉男;王浩;張濤;;介入栓塞治療不同體積肝血管瘤的臨床療效及血流動力學(xué)特征[J];肝臟;2016年06期

6 趙振宇;;腹腔鏡與開腹手術(shù)治療肝血管瘤的對比觀察[J];現(xiàn)代養(yǎng)生;2016年12期

7 江四鋒;談帥;宋冉;;血管瘤行腹腔鏡肝切除術(shù)的效果探究[J];中國繼續(xù)醫(yī)學(xué)教育;2016年17期

8 李柳生;陳斌;陳健健;;腹腔鏡下肝部分切除治療肝血管瘤的臨床療效[J];黑龍江醫(yī)藥;2016年03期

9 劉鵬宇;單孝軍;劉寶翠;張麗君;齊俊燕;;腹腔鏡與開腹手術(shù)治療肝血管瘤的對比分析[J];中國現(xiàn)代藥物應(yīng)用;2016年10期

10 林俊平;王良坤;徐剛潮;李錦良;;腹腔鏡與開腹肝血管瘤切除術(shù)對患者術(shù)后恢復(fù)的影響分析[J];中華普外科手術(shù)學(xué)雜志(電子版);2016年01期

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