镍钛记忆合金加压吻合夹在消化道吻合术中的系统评价及序贯分析

发布时间：2018-05-09 05:50

本文选题：组织工程 + 合金　；参考：《中国组织工程研究》2017年18期

【摘要】：背景:镍钛记忆合金加压吻合夹已经被用于消化道吻合术,但其有效性和安全性仍存在争议。目的:评价镍钛记忆合金加压吻合夹(Ni-Ti CAC)在消化道吻合术中的有效性及安全性。方法:计算机检索Pub Med,Embase,Cochrane Library相关期刊论文(CNKI),中国生物医学文献数据库(CBM),万方及维普(VIP)数据库。检索时间:从建库至2017年1月15日。检索词:镍钛记忆合金、加压吻合夹、吻合术、胃、空肠、回肠、小肠、结肠、直肠及大肠等。纳入消化道吻合术中应用镍钛记忆合金加压吻合夹对比常用消化道吻合方法的随机对照试验文献,对其吻合时间、术后排气时间以及术后住院时间进行Meta分析,并采用TSA v0.9软件进行序贯分析。结果与结论:共纳入18篇随机对照试验文献,共1 860例行消化道吻合术患者。Meta分析结果显示,镍钛记忆合金加压吻合夹的使用能缩短术中吻合时间(MD=-3.83,95%CI:-6.48至-1.19,P=0.004)、术后排气时间(MD=-0.14,95%CI:-0.22至-0.05,P=0.002),但对于术后住院时间改变无明显差异(MD=-0.83,95%CI:-1.82至0.16,P=0.10)。GRADE质量评价表明所述指标证据质量为中低级。序贯分析提示Meta分析在术后排气时间方面,镍钛记忆合金加压吻合夹组优于对照组获得证实。在不良反应上,除死亡1例外,最常见的是切口感染,其他还可见肺栓塞及腹痛等。结果证实,镍钛记忆合金加压吻合夹可以在消化道吻合术减少吻合时间,加快术后排气,在消化道吻合术中具有较好的安全性。由于目测纳入试验的设计缺陷,今后研究仍需多中心、高质量的随机对照试验支持。
[Abstract]:Background: Nickel-titanium memory alloy pressure clamp has been used in gastrointestinal anastomosis, but its efficacy and safety are still controversial. Objective: to evaluate the efficacy and safety of Ni-Ti CAC in gastrointestinal anastomosis. Methods: Pub Medbase Cochrane Library full-text database, Chinese biomedical literature database, Wannfang and Weipu VIPdatabases were searched by computer. Retrieval time: from the construction of the database to January 15, 2017. Keywords: nickel titanium memory alloy, pressure anastomosis clamp, anastomosis, stomach, jejunum, ileum, small intestine, colon, rectum and large intestine. A randomized controlled trial was carried out to analyze the time of anastomosis, the time of exhaust and the length of hospital stay in the digestive tract anastomosis by using Ni-Ti memory alloy pressurized anastomosis clip to compare the common anastomosis methods of digestive tract anastomosis. TSA v0.9 software was used for sequential analysis. Results and conclusion: a total of 18 articles of randomized controlled trials were included. A total of 1 860 patients undergoing digestive tract anastomosis were analyzed by meta analysis. The application of Nickel-Titanium memory Alloy pressure anastomosis clip can shorten the intraoperative anastomosis time (CI: -6.48 to -1.19P0. 004), and the postoperative exhaust time is MD-0.1495 CIW -0.22 to -0.05P0. 002, but there is no significant difference in the change of postoperative hospitalization time. The evaluation of the quality of grade indicates that the quality of the indexes mentioned above is middle and low. Sequential analysis showed that Meta analysis was better than that of the control group in terms of exhaust time after operation in Nickel-Titanium memory alloy pressurized clamp group. In adverse reactions, except for 1 death, incision infection was the most common, and pulmonary embolism and abdominal pain were also seen. The results showed that the pressure clamp of Ni-Ti memory alloy could reduce the anastomosis time and accelerate the postoperative exhaust after gastrointestinal anastomosis, and it had better safety in digestive tract anastomosis. Due to the design defect of visual test, the future research still needs the support of multi-center, high quality randomized controlled trial.
【作者单位】：广州中医药大学第一附属医院胃肠外科;广州中医药大学第一临床医学院;广州中医药大学第四临床医学院;
【基金】：国家自然科学基金青年科学基金项目(81303148) 广东省自然科学基金(2016A030313643)~~
【分类号】：R656

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