腹腔镜与开腹全结肠切除治疗IBD、FAP、STC安全性的meta分析

发布时间：2018-05-06 00:19

本文选题：全结肠切除 + 腹腔镜手术　；参考：《青海大学》2015年硕士论文

【摘要】：目的:通过Meta分析对腹腔镜与传统开腹全结肠切除术治疗全结肠疾病的安全性进行综合评价。方法:检索Pub Med、Cochrance Library、Embase、Web of Science、万方、维普、中国知网等数据库,语种为中英文文献,两名评价员根据纳入标准与排除标准选择文献,提取相关资料,采用REVMAN 5.2软件进行meta分析。结果:最终获得文献6篇(226例),其中1篇为随机对照试验。Meta分析结果显示:手术时间:SMD=49.93,CI=[-26.8,126.45],P=0.20,两种手术方式在手术时间的差异无统计学意义。术中估计出血量:SMD=-0.41,CI=[-0.68,-0.14],P=0.003。两种手术方式在术中出血量的差异有统计学意义。术后胃肠道功能恢复时间:SMD=-1.11,95%CI=[-1.72,-0.50],P0.0003。两种手术方式在胃肠道功能恢复时间上的差异具有统计学意义。术后住院时间:MD=-5.73,95%CI=[-5.99,-4.75],P0.00001,差异具有统计学意义。吻合口瘘发生率:OR=0.49,95%CI=[0.17,1.43],P=0.19。术后吻合口瘘发生的差异无统计学意义。肠梗阻发生的比较:OR=0.40,95%CI=[0.16,1.00],P=0.05,差异无统计学意义。切口感染:OR=0.53,95%CI=[0.22,1.31],P=0.17,差异无统计学意义。切口长度:MD=-10.68,95%CI=[-10.95,-10.41],P0.00001,差异有统计学意义。结论:腹腔镜全结肠切除在手术时间、切口感染、肠梗阻发生率、吻合口瘘发生率上无统计学差异,但可减少术中出血、缩短手术切口,缩短胃肠道功能恢复时间,从而减少术后住院时间。因此在临床上对于不同情况的患者,应按照循证医学思维模式,严格术前评估而采取个体化的治疗。考虑所纳入文献质量不同,仍需大样本随机对照研究提供更加充足的临床指导证据。
[Abstract]:Objective: to evaluate the safety of laparoscopic and traditional open colectomy in the treatment of total colonic diseases by Meta analysis. Methods: the Pub Medrance Cochrance Library Embase Web of Science, Wanfang, Weipu and ChinaNet databases in Chinese and English were searched. According to the inclusion criteria and exclusion criteria, two evaluators selected the literature and extracted the relevant data. Meta analysis was carried out with REVMAN 5.2 software. Results: a total of 226 cases with 6 references were obtained, of which 1 was a randomized controlled trial. Meta-analysis showed that the operative time was 49.93 CI = [-26.8126.45], and there was no significant difference between the two operative methods in the operation time. The intraoperative blood loss was estimated to be 0.41% SMD-0.41% CI = [-0.68 卤0.14] P0. 003. There was a significant difference in the amount of intraoperative bleeding between the two types of operation. The recovery time of gastrointestinal function after operation was: SMD-1.1195 CI = [-1.72 卤0.50] P 0.0003. There was significant difference in the recovery time of gastrointestinal function between the two surgical methods. The postoperative hospitalization time was 1: 00 MDN -5.73N 95 CI = [-5.99 卤-4.75] P 0.00001, the difference was statistically significant. The incidence of anastomotic leakage was 0.49% (CI = 0.171.43) and 0.19% (P < 0.05). There was no significant difference in the occurrence of anastomotic leakage after operation. There was no significant difference in the incidence of intestinal obstruction (CI = [0.161.00] P0. 05). There was no significant difference in wound infection between 0.53% and 95% (CI = [0.22 卤1.31]) (P = 0.17). The incision length: MD-10.68C95% CI = [-10.95U -10.41] P0.00001, the difference was statistically significant. Conclusion: laparoscopic total colectomy has no significant difference in operative time, incision infection, intestinal obstruction and anastomotic leakage, but it can reduce intraoperative bleeding, shorten operative incision and shorten gastrointestinal function recovery time. So as to reduce postoperative hospital stay. Therefore, individualized treatment should be taken according to the thinking mode of evidence-based medicine and strict preoperative evaluation for patients with different clinical conditions. Considering the different quality of literature included, it is still necessary to provide more sufficient clinical guidance evidence in large sample randomized controlled trials.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.9

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