腹腔镜联合胆道镜与开腹手术治疗胆总管结石疗效比较的Meta分析

发布时间：2018-03-02 03:17

本文关键词： 胆总管结石腹腔镜胆道镜开腹手术　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:比较腹腔镜联合胆道镜胆总管切开取石术与开腹手术在胆总管结石治疗方面的临床疗效和安全性。方法:计算机检索CBMdisc、CNKI、Wan Fang Data、VIP,使用“胆总管结石”、“腹腔镜”、“胆道镜”、“开腹手术”等检索词进行关键词检索;以“common bile duct calculi”、“open surgery”、“laparoscopic common bile duct exploration”、“choledochoscopy”为检索词检索Pub Med、Cochrane Library、EMBASE。检索从各建库时间到2014年12月。手工检索已经发表的关于腹腔镜联合胆道镜与开腹手术比较治疗胆总管结石的国内外文献,并追查相关纳入文献的参考文献,使用Revman 5.0软件完成相关手术指标的Meta分析,采用比值比(OR值),加权均数差(WMD)和95%置信区间(95%CI)进行疗效的评价,最后对分析结果进行整理并发表。结果:此次纳入Meta分析的文献共21篇,其中,中文17篇,英文4篇,共2600例患者。Meta分析结果显示:腹腔镜联合胆道镜治疗胆总管结石的疗效优于开腹手术。在手术时间方面,腹腔镜联合胆道镜组长于开腹手术组,WMD值等于6.27,95%的置信区间为(4.81,7.73),P㩳0.05。在术中出血量方面,腹腔镜联合胆道镜组少于开腹手术组,WMD值等于-109.82,95%的置信区间为(-112.26,-107.39),P㩳0.05。双镜组在术后下床活动时间上优于开腹组,WMD值等于-34.56,95%的置信区间为(-38.89,-30.24),P㩳0.05。双镜组在术后首次排气时间上优于开腹组,WMD值等于-37.54,95%的置信区间为(-38.11,-36.98),P㩳0.05。手术总并发症发生率OR值0.24,95%的置信区间(0.17,0.35),双镜组优于开腹组。使用止痛剂情况OR值0.13,95%的置信区间(0.10,0.18),双镜组优于开腹组。在结石残余率方面,双镜组和开腹组的差异无统计学意义。结论:在术中失血量、术后下床活动时间、术后住院时间、术后首次排气时间、使用止痛剂、并发症发生率,双镜组都优于开腹手术组。在手术时间方面,开腹组优于双镜组。结石残余率方面,两组差异无统计学意义。
[Abstract]:Objective: to compare the clinical efficacy and safety of laparoscopic choledocholithotomy combined with laparoscopic choledocholithotomy in the treatment of choledocholithiasis. "choledochoscope", "open surgery" and other key words for keyword retrieval; "common bile duct calculi", "open surgery", "laparoscopic common bile duct exploration" and "choledochoscopy" were used to search Pub Meda Cochrane Library EMBASE.Retrieval of published literatures on the comparison of laparoscopic choledochoscopy and open choledocholithiasis for common bile duct calculi was carried out manually from December 2014 to December 2014. The related references were followed up, and the Meta analysis of the related surgical indexes was completed by using Revman 5.0 software. The therapeutic effect was evaluated by the ratio ratio ratio or value, the weighted mean difference (WMD) and the 95% confidence interval (95 CI). Results: there were 21 articles including 17 in Chinese and 4 in English, which were included in the Meta analysis. Meta-analysis of 2600 patients showed that laparoscopic combined choledochoscopy was more effective than open surgery in the treatment of choledocholithiasis. In terms of intraoperative bleeding volume, the confidence interval of WMD value of laparoscopy combined with choledochoscope group was less than that of open operation group (-109.82 卤95%). The confidence interval of Laparoscopic combined choledochoscope group was -112.26 ~ 107.39? The results showed that the WMD of the double mirror group was better than that of the open group in the time of getting out of bed. The confidence interval of WMD equal to -34.56% was -38.89% -30.24% P? The confidence interval of WMD equal to -37.54-95% in the double-mirror group was -38.11 ~ 36.98 ~ (-36.98), which was better than that in the open group in the first time of exhaust after operation. 0. 05. The OR of the total complication rate of operation is 0.24 95% confidence interval 0.17 ~ 0.35%, the double mirror group is superior to the open operation group. The OR value of 0.13 ~ 95% confidence interval is 0.100.18%, the double mirror group is better than the open operation group, and the residual rate of stone is better in the double mirror group than in the laparotomy group, in the case of analgesic agent, the OR value of 0.1395% confidence interval is 0.100.18%. There was no significant difference between the two groups. Conclusion: the blood loss during operation, the time of getting out of bed after operation, the time of hospitalization, the time of first exhaust after operation, the use of analgesics, the incidence of complications, In the operation time, the open group was better than the double mirror group. The residual rate of stone in the two groups had no statistical significance.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.42

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