快速康复外科在妇科恶性肿瘤手术应用的系统评价

发布时间：2018-04-06 03:17

本文选题：快速康复外科理念　切入点：妇科恶性肿瘤手术　出处：《吉林大学》2017年硕士论文

【摘要】：目的:系统地评价快速康复外科理念(fast-track surgery,FTS)在妇科恶性肿瘤手术中应用的有效性和安全性。方法:通过计算机检索相关的国内外数据库查找相关的文献,比如中国知网数据库(CNKI)、万方数据库、维普数据库、Pubmed数据库、EMbase数据库及Cochrane library数据库等,文献的检索时间限定为2001年01月至2016年12月,检索语言限定为中文与英文。根据本次研究的目的严格地制定和执行纳入标准及排除标准,纳入的文献研究包括相关的随机和非随机对照试验,对所纳入文献的评价严格按照Cochrane协作网推荐的系统评价的原则和方法执行,提取相关的研究数据后,对各组数据采用Revman 5.3软件进行系统评价分析。结果:最终纳入12篇文献,包括8篇中文随机对照试验和4篇英文非随机对照试验(2篇病例—对照试验,2篇队列研究)。FTS组与对照组相比较,Meta分析结果显示:(1).术后30天返院率结果差异无统计学意义(OR=1.02,95%CI[0.63,1.66],P=0.93);(2).死亡率结果差异无统计学意义(OR=0.95,95%CI[0.26,3.41],P=0.93);(3).术后并发症率结果差异具有显著统计学意义(OR=0.49,95%CI[0.32,0.73],P=0.0006);(4).术后恢复肠内营养时间结果差异具有显著的统计学意义(SMD=㧟5.26,95%CI[㧟7.91,㧟2.61],P0.0001);(5).术后排气时间结果差异具有显著的统计学意义(SMD=㧟1.56,95%CI[㧟2.15,㧟0.96],P0.00001);(6).术后下床活动时间结果差异具有显著的统计学意义(SMD=㧟4.23,95%CI[㧟6.09,㧟2.36],P0.00001);(7).术后排便时间的结果差异具有显著的统计学意义(SMD=㧟1.31,95%CI[㧟1.99,㧟0.64],P=0.0001);(8).术后住院时间缩短,结果差异具有显著的统计学意义,(SMD=㧟1.21,95%CI[㧟1.65,㧟0.77],P0.00001);(9).住院费用有所减少,结果差异具有显著的统计学意义(SMD=㧟1.84,95%CI[㧟3.00,㧟0.67],P=0.002)。结论:与传统围手术期常规治疗方案相比较,将快速康复外科理念应用于妇科恶性肿瘤患者的围手术期,可以加快患者术后排气排便,早期恢复肠道营养及下床活动,缩短住院时间,降低住院费用,降低术后并发症的发生率,且返院率、死亡率并不增加。这说明快速康复外科理念应用于妇科恶性肿瘤患者的围手术期是安全有效的,且与传统围手术期常规治疗方案比较存在一定优势。
[Abstract]:Objective: to evaluate the efficacy and safety of fast-track Surgeryn FTS (FTS) in gynecologic malignant tumor surgery.Methods: the relevant literatures were searched by computer, such as CNKI database, Wanfang database, Embase database and Cochrane library database, etc.The retrieval time is limited from January 2001 to December 2016, and the retrieval languages are Chinese and English.For the purposes of this study, inclusion criteria and exclusion criteria are strictly developed and implemented, and the literature included in the study includes relevant randomized and non-randomized controlled trials.According to the principles and methods of system evaluation recommended by Cochrane Cooperative Network, the relevant research data were extracted, and the data of each group were evaluated and analyzed by Revman 5.3 software.Results: 12 literatures were included, including 8 Chinese randomized controlled trials and 4 English non-randomized controlled trials with 2 case-control trials and 2 cohort studies. The results of Meta-analysis in FTS group were higher than those in control group.There was no significant difference in the rate of return to hospital 30 days after operation. There was no significant difference in CI (0.63 卤1.66).There was no significant difference in mortality results between two groups.The difference of postoperative complication rate was statistically significant (P < 0. 006).There was significant difference in the time of recovery of enteral nutrition after operation. There was a significant difference in the time of recovery of enteral nutrition. There was a significant difference in CI (5.26 ~ 95 CI) (P = 0.0001) and there was no significant difference between the two groups (P = 0.0001).The difference of postoperative exhaust time was statistically significant (P 0.00001).There was significant difference in the time of getting out of bed after operation. There was a significant difference in SMD-4.2395 CI [6.09 ~ 2.36] (P 0.00001).The difference of postoperative defecation time was statistically significant (P < 0.01).The postoperative hospitalization time was shortened, and the difference was statistically significant (P 0.00001).The cost of hospitalization decreased, and the difference was statistically significant (P < 0.05).Conclusion: compared with the conventional treatment plan in perioperative period, applying the concept of rapid rehabilitation surgery to the perioperative period of gynecological malignant tumor patients can accelerate the postoperative exhaust and defecation, early recovery of intestinal nutrition and activity out of bed.The length of hospitalization, the cost of hospitalization, the incidence of postoperative complications, and the rate of return to hospital did not increase.This indicates that the concept of rapid rehabilitation surgery is safe and effective in the perioperative period of gynecologic malignant tumor patients, and has some advantages compared with the conventional treatment plan in the traditional perioperative period.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.3

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