胆囊切除与大肠癌关系的Meta分析

发布时间：2018-07-09 13:44

本文选题：胆囊切除 + 大肠癌　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:通过Meta分析评价胆囊切除和大肠癌的关系,以便于指导临床,早期筛查,预防大肠癌的发生。研究方法:检索中文生物医学文献数据库(CBM)、相关期刊论文(China national knowledge infrastructure,CNKI)、万方数据库、维普数据库(VBM)、PubMed、EMBASE、Web of Science、Cochrane Library等数据库,时间自建库起截止至2016年10月31日,收集国内外公开发表的有关胆囊切除与大肠癌关系的文献。纳入涉及胆囊切除与大肠癌关系的病例对照研究或前瞻性队列研究文献。用Stata 13.0软件进行Meta分析。病例对照研究中,将OR值及其95%可信区间(95%CI)进行合并,前瞻性队列研究中,将RR值及其95%可信区间(95%CI)进行合并,分析胆囊切除与大肠癌的关系。结果:严格按照文献纳入标准及排除标准,共纳入61篇文献,其中病例对照研究56篇,前瞻性队列研究5篇。1.病例对照研究(1)总研究对象的Meta分析胆囊切除与大肠癌发生有关,且其能够促进大肠癌的发生[OR=1.58,95%CI 1.39-1.79,P=0.000]。(2)亚组分析1)性别病例对照研究显示女性患者行胆囊切除术后患大肠癌的风险增加[OR=1.30,95%CI 1.07-1.58,P=0.009],而胆囊切除不会增加男性患者患大肠癌的风险[OR=1.14,95%CI 0.93-1.40,P=0.195]。2)肿瘤部位胆囊切除能够促进结肠癌尤其是右半结肠癌的发生(结肠癌:[OR=1.40,95%CI 1.18-1.65,P=0.000],右半结肠癌:[OR=2.17,95%CI 1.40-3.38,P=0.001]),与直肠癌及左半结肠癌的发生无关(直肠癌:[OR=0.88,95%CI 0.74-1.04,P=0.143],左半结肠癌:[OR=1.02,95%CI 0.76-1.37,P=0.901])。3)对照组人群以医院人群为对照组的研究提示胆囊切除会增加大肠癌发生的风险[OR=1.92,95%CI 1.62-2.26,P=0.000],以社区人群为对照组的研究提示胆囊切除术后患者患大肠癌的风险无增加[OR=1.03,95%CI 0.88-1.22,P=0.701]。4)地区胆囊切除能够增加欧洲及亚洲地区人群大肠癌的发病率(欧洲:[OR=1.37,95%CI 1.06-1.77,P=0.015];亚洲:[OR=2.35,95%CI 1.89-2.90,P=0.000]),但不能够增加大洋洲以及北美洲地区大肠癌的发病率(大洋洲:[OR=1.06,95%CI 0.7-1.62,P=0.773],北美洲:[OR=1.03,95%CI 0.96-1.11,P=0.351]),且亚洲地区胆囊切除与大肠癌的发生有显著相关性。2.前瞻性队列研究前瞻性队列研究显示胆囊切除不会增加男性及女性患者患大肠癌的风险(男性:[OR=1.10,95%CI 0.85-1.43,P=0.471],女性:[OR=1.16,95%CI 0.96-1.41,P=0.120])。结论:1.胆囊切除术可能会促进大肠癌的发生。2.胆囊切除可能增加女性患者患右半结肠癌的风险。3.胆囊切除能够增加亚洲及欧洲地区患者患大肠癌的风险,其中亚洲地区人群行胆囊切除术后更易患大肠癌。
[Abstract]:Objective: to evaluate the relationship between cholecystectomy and colorectal cancer by meta-analysis, so as to guide clinical practice, early screening and prevention of colorectal cancer. Methods: the Chinese Biomedical Literature Database (CBMs), China national knowledge Infrastructure Database (CNKI), Wanfang Database (VBM) and PubMedmatin Web of Science and Technology Cochrane Library (CBMs) were searched. The database was built from October 31, 2016. To collect the published literature on the relationship between cholecystectomy and colorectal cancer. Included in case-control studies or prospective cohort studies involving the relationship between cholecystectomy and colorectal cancer. Meta-analysis was carried out with Stata 13.0 software. In the case-control study, OR value and 95% confidence interval (95 CI) were combined. In prospective cohort study, RR value and 95% confidence interval (95 CI) were combined to analyze the relationship between cholecystectomy and colorectal cancer. Results: according to the inclusion criteria and exclusion criteria, 61 articles were included, including 56 case-control studies and 5 prospective cohort studies. Case control study (1) Meta-analysis of the total study subjects Cholecystectomy was associated with colorectal cancer. And it can promote the occurrence of colorectal cancer [ORN 1.5895 CI 1.39-1.79 P0.000] (2) subgroup analysis 1) gender case-control study showed that female patients had an increased risk of colorectal cancer after cholecystectomy [OR1. 3095 CI 1.07-1.58P0. 009], while cholecystectomy did not increase the risk of colorectal cancer in male patients. Risk [OR1.1495 CI 0.93-1.40 Pu 0.195] .2) Cholecystectomy at the tumor site promotes the occurrence of colon cancer, especially the right colon cancer (colon cancer: [OR1.409595 CI 1.18-1.65P0.000], right colon cancer: [OR2.17995 95 CI 1.40-3.38P0.001]), not associated with the occurrence of rectal cancer and left semicolon cancer (rectal cancer: [OR0.8895CI 0.74-1.04P0.143], left semicolon: [OR1.0295CI 0.76-1.37 P0.901] .3) The study of hospital population in control group showed that cholecystectomy increased the risk of colorectal cancer [ORG 1.92 95 CI 1.62-2.26 P0. 000], and the study of community population as control group suggested that there was no increase in the risk of colorectal cancer in patients after cholecystectomy [OR1. 03% 95 CI 0.88-1.22 P0. 701] Regional cholecystectomy can increase the incidence of colorectal cancer among people in Europe and Asia (Europe: 1.37 / 95 CI 1.06-1.77 P0.015; Asia: [OR2.355.95 CI 1.89-2.90 P0.000]), but does not increase the incidence of colorectal cancer in Oceania and North America (Oceania: [OR1.06995CI 0.7-1.62P0.773], North America: [OR1.0395CI 0.96-1.11P0.351]), and Cholecystectomy and colorectal cancer in Asia have a significant correlation. 2. 2. Prospective cohort studies showed that cholecystectomy did not increase the risk of colorectal cancer in both men and women (male: 1.1095 CI 0.85-1.43P0.471, female: [OR1.1695CI 0.96-1.41P0.120]). Conclusion 1. Cholecystectomy may promote the development of colorectal cancer. 2. 2. Cholecystectomy may increase the risk of right colon cancer in women. Cholecystectomy increases the risk of colorectal cancer in patients in Asia and Europe, with people in Asia more likely to develop colorectal cancer after cholecystectomy.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34;R657.4

【参考文献】