内镜与开放组织结构分离技术:近期疗效比较的Meta分析

发布时间：2018-10-24 18:38

【摘要】：目的:系统评价开放与内镜下组织结构分离技术的近期疗效.方法:通过互联网检索Pub Med、Spinger Link、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REVMAN5.2软件进行meta分析。结果:经过计算机检索初检出相关文献共838篇,其中中文文献115篇,英文文献723篇。剔除动物实验、重复发表及明显不符合纳入标准的初检文献,经过阅读文题和摘要初筛后纳入323篇文献。再经过标准及排除标准严格筛选,最终共纳入64篇文献,8篇为对照研究文献,56篇为病例研究文献,其中包括7篇英文文献和1篇中文文献,共有408例患者,其中CST组193例,ECST组215例。56篇病例研究结果显示:术后的并发症内镜组少于开放组。Meta分析结果显示:术后住院时间:MD=0.20,95%CI=[-0.54,0.13],P=0.23。认为两种手术方式在手术时间的差异无统计学意义。术后复发率:MD=0.6,95%CI=[0.29,1.46],P=0.30。认为两种手术方式在复发率的差异无统计学,术后并发症包括伤口感染率OR=0,95%CI=[0.050.04],P=0.91、认为两种手术方式在伤口感染率的差异无统计学意义。伤口脓肿形成率OR=-0.01,95%CI=[-0.06,-0.04],P=0.61.认为两种手术方式在伤口脓肿形成率的差异无统计学意义。伤口血清/血清肿发生率OR=0.63,95%CI=[0.29,1.38],P=0.25,认为两种手术方式在伤口血清/血清肿发生率的差异无统计学意义。手术时间:MD=29.67,95%CI=[6.93,52.42],P=0.01。两种手术方式在手术时间的差异有统计学意义。术后伤口皮肤裂开率OR=0.35,95%CI=[0.16,0.78],P=0.01认为两种手术方式在皮肤裂开率的差异有统计学意义。组织坏死清创率OR=0.02,95%CI=[0.08,-0.45],P=0.0002,认为两种手术方式在皮肤裂开率的差异有统计学意义。结论:从MATA分析ECST与CST相比:ECST手术时间比CST短,ECST可减少术后并发症包括伤口皮肤裂开率、伤口血清/血清肿发生率,然而在手术时间、住院时间、术后复发、术后伤口感染率、伤口脓肿形成率、伤口血清/血清肿发生率上无统计学差异。56篇病例研究分析得到,ECST术后并发症少于CST组。因此临床上对于不同的患者,应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证据。
[Abstract]:Objective: to evaluate the short-term efficacy of open and endoscopic tissue structure separation. Methods: the databases of Pub Med,Spinger Link,Cochrance Library,Embase,Web of Science, Wanfang, Weipu and Chinatown were searched on the Internet in Chinese and English. The two evaluators selected the documents according to the inclusion criteria and exclusion criteria, and extracted the relevant data. Meta analysis was carried out with REVMAN5.2 software. Results: a total of 838 literatures were initially identified by computer retrieval, 115 of which were in Chinese and 723 in English. The original literature which was published repeatedly and obviously did not meet the inclusion criteria was excluded from animal experiments and 323 articles were included after preliminary screening of reading questions and abstracts. After strict selection of criteria and exclusion criteria, 64 articles were included, 8 were controlled studies, 56 were case studies, including 7 English and 1 Chinese. 408 patients were included in the study. There were 193 cases in CST group and 215 cases in ECST group. The results of 56 cases showed that the postoperative complications in endoscopic group were less than those in open group. Meta analysis showed that the postoperative hospitalization time was MD=0.20,95%CI= [-0.54 卤0.13], and the postoperative complication was 0.23. It was concluded that there was no significant difference in the operative time between the two types of operation. Postoperative recurrence rate: MD=0.6,95%CI= [0.29 卤1.46], P < 0.30. The results showed that there was no significant difference in the recurrence rate between the two surgical methods. The postoperative complications included wound infection rate (OR=0,95%CI=) [0.050.04], P0. 91. It was concluded that there was no significant difference between the two surgical methods in wound infection rate. The rate of formation of wound abscess was OR=-0.01,95%CI= [- 0.06- 0.04], P0. 61. It was concluded that there was no significant difference in the rate of wound abscess formation between the two surgical methods. The incidence rate of serum / serum swelling in wound [0.29 1.38], P < 0.25, it was concluded that there was no significant difference between the two surgical methods in the incidence of serum / serum swelling in the wound. Time of operation: MD=29.67,95%CI= [6.93% 52.42], P < 0.01. The difference of operation time between two kinds of operation methods was statistically significant. The wound skin rupture rate (OR=0.35,95%CI=) was 0.160.78, and the difference between the two surgical methods was statistically significant. The debridement rate of tissue necrosis (OR=0.02,95%CI=) [0.08- 0.45] and the rate of tissue necrosis debridement were 0.0002. It was concluded that the difference between the two surgical methods in the rate of skin rupture was statistically significant. Conclusion: compared with CST, ECST has shorter operation time than CST. ECST can reduce the rate of postoperative complications, such as the rate of wound skin rupture, the incidence of serum / serum swelling. However, in the operation time, hospital stay, postoperative recurrence and postoperative wound infection rate, ECST can reduce the incidence of postoperative complications. There was no significant difference in the rate of wound abscess and the incidence of serum / serum swelling in the wound. 56 cases were studied and analyzed. The complications after ECST were less than those in CST group. Therefore, individualized treatment should be applied to different patients before operation. Considering the different quality of literature included, large-sample randomized controlled studies are still needed to provide evidence.
【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

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