比较腹腔镜法及传统手术法腹透管植入术安全性及导管生存率的meta分析

发布时间：2018-11-04 08:02

【摘要】：目的：腹膜透析(Peritoneal Dialysis)是现代肾脏替代治疗方法的基本方法之一。腹膜透析管是腹透患者的“生命线”,但各种导管相关并发症会影响腹透管功能,很多病人甚至因此退出腹膜透析。目前已有许多观察性研究报道了腹透管植入方法会影响导管相关并发症的发生率,本文旨在通过对这些临床研究进行meta分析以比较腹腔镜及常规腹膜透析置管术的安全性及导管生存率。方法：以“腹膜透析"、“腹腔镜”为主要检索词检索中国知网、维普等数据库,以"peritoneal dialysis"、"peritoneoscopic"、"peritoneoscopy"、"laparoscopy"及"laparoscopic"等主要检索词检索Pubmed、Elsevier Sciencedirect、Cochrane Library及Springer等外文数据库。收集比较两种腹膜透析置管方式安全性及导管生存率随机对照试验或观察性研究。采用R evMan5.3软件进行统计处理,最后对所有结论采用GRADE标准进行证据质量分级,并制作结果汇总表,所用软件为GRADEprofiler3.6。结果：通过计算机检索得到文献共553篇,经过初筛及全文筛选,共入选文献19篇。Meta分析结果显示：腹腔镜下置管术在控制导管移位方面优于传统手术(OR 0.22,95% CI 0.13 to 0.39; P0.00001),但会轻微增加出血的风险(OR 2.13,95% CI 1.07 to 4.23; P= 0.03),而两组手术在其它导管相关并发症方面无显著性差异。另外,腹腔镜置管术较传统手术的导管生存率高(1年生存率：OR 2.64,95% CI 1.69 to 4.14;P0.0001；2年生存率：OR 2.18,95% CI 1.48 to 3.21; P0.0001)。以上结果的GRADE分级只有腹透管移位的研究质量为A级,其余皆为B级或C级。总体研究质量属于中等。结论：总体而言,腹腔镜置管术较传统手术能减少导管移位及提高导管生存率,但会轻微增加出血风险,本研究总体质量属于中等,尚需进一步研究支持。
[Abstract]:Objective: peritoneal dialysis (Peritoneal Dialysis) is one of the basic methods of modern renal replacement therapy. Peritoneal dialysis tube is the lifeline of peritoneal dialysis patients, but many patients even quit peritoneal dialysis because of various catheter related complications. At present, there have been many observational studies on the incidence of catheter-related complications that can be affected by the implantation of abdominal dialysis tubes. The purpose of this study was to compare the safety and survival rate of laparoscopic and conventional peritoneal dialysis catheterization by meta analysis of these clinical studies. Methods: using "peritoneal dialysis" and "laparoscopy" as the main keywords to search the database of China Zhiwang, Weip and other databases, Pubmed,Elsevier Sciencedirect, was searched with the main keywords of "peritoneal dialysis", "peritoneoscopic", "peritoneoscopy", "laparoscopy" and "laparoscopic". Cochrane Library, Springer and other foreign language databases. A randomized controlled trial or observational study was conducted to compare the safety and survival rate of two peritoneal dialysis catheterization methods. R evMan5.3 software is used for statistical processing. Finally, GRADE standard is used to classify the quality of evidence, and a summary table of results is made. The software used is GRADEprofiler3.6.. Results: a total of 553 articles were obtained by computer retrieval. The results of Meta analysis showed that laparoscopic catheterization was superior to traditional operation in controlling catheter displacement (OR 0.2295% CI 0.13 to 0.39; P0.00001, but slightly increased the risk of bleeding (OR 2.1395% CI 1.07 to 4.23; P = 0.03), but there was no significant difference in other catheter-related complications between the two groups. In addition, the catheter survival rate of laparoscopic catheterization was higher than that of conventional catheterization (1-year survival rate: OR 2.64%, 95% CI 1.69 to 4.14 P0.0001; 2-year survival rate: OR 2.1895% CI 1.48 to 3.21; P0.0001). The GRADE grade of the above results was only A grade for abdominal canal transposition, while the others were B or C grade. The overall quality of research is medium. Conclusion: in general, laparoscopic catheterization can reduce catheter displacement and improve catheter survival rate, but it will slightly increase the risk of bleeding. The overall quality of this study is moderate and needs further research support.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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