【摘要】：目的：腹膜透析(Peritoneal Dialysis)是現(xiàn)代腎臟替代治療方法的基本方法之一。腹膜透析管是腹透患者的“生命線”,但各種導管相關并發(fā)癥會影響腹透管功能,很多病人甚至因此退出腹膜透析。目前已有許多觀察性研究報道了腹透管植入方法會影響導管相關并發(fā)癥的發(fā)生率,本文旨在通過對這些臨床研究進行meta分析以比較腹腔鏡及常規(guī)腹膜透析置管術的安全性及導管生存率。方法：以“腹膜透析"、“腹腔鏡”為主要檢索詞檢索中國知網(wǎng)、維普等數(shù)據(jù)庫,以"peritoneal dialysis"、"peritoneoscopic"、"peritoneoscopy"、"laparoscopy"及"laparoscopic"等主要檢索詞檢索Pubmed、Elsevier Sciencedirect、Cochrane Library及Springer等外文數(shù)據(jù)庫。收集比較兩種腹膜透析置管方式安全性及導管生存率隨機對照試驗或觀察性研究。采用R evMan5.3軟件進行統(tǒng)計處理,最后對所有結論采用GRADE標準進行證據(jù)質(zhì)量分級,并制作結果匯總表,所用軟件為GRADEprofiler3.6。結果：通過計算機檢索得到文獻共553篇,經(jīng)過初篩及全文篩選,共入選文獻19篇。Meta分析結果顯示：腹腔鏡下置管術在控制導管移位方面優(yōu)于傳統(tǒng)手術(OR 0.22,95% CI 0.13 to 0.39; P0.00001),但會輕微增加出血的風險(OR 2.13,95% CI 1.07 to 4.23; P= 0.03),而兩組手術在其它導管相關并發(fā)癥方面無顯著性差異。另外,腹腔鏡置管術較傳統(tǒng)手術的導管生存率高(1年生存率：OR 2.64,95% CI 1.69 to 4.14;P0.0001；2年生存率：OR 2.18,95% CI 1.48 to 3.21; P0.0001)。以上結果的GRADE分級只有腹透管移位的研究質(zhì)量為A級,其余皆為B級或C級�？傮w研究質(zhì)量屬于中等。結論：總體而言,腹腔鏡置管術較傳統(tǒng)手術能減少導管移位及提高導管生存率,但會輕微增加出血風險,本研究總體質(zhì)量屬于中等,尚需進一步研究支持。
[Abstract]:Objective: peritoneal dialysis (Peritoneal Dialysis) is one of the basic methods of modern renal replacement therapy. Peritoneal dialysis tube is the lifeline of peritoneal dialysis patients, but many patients even quit peritoneal dialysis because of various catheter related complications. At present, there have been many observational studies on the incidence of catheter-related complications that can be affected by the implantation of abdominal dialysis tubes. The purpose of this study was to compare the safety and survival rate of laparoscopic and conventional peritoneal dialysis catheterization by meta analysis of these clinical studies. Methods: using "peritoneal dialysis" and "laparoscopy" as the main keywords to search the database of China Zhiwang, Weip and other databases, Pubmed,Elsevier Sciencedirect, was searched with the main keywords of "peritoneal dialysis", "peritoneoscopic", "peritoneoscopy", "laparoscopy" and "laparoscopic". Cochrane Library, Springer and other foreign language databases. A randomized controlled trial or observational study was conducted to compare the safety and survival rate of two peritoneal dialysis catheterization methods. R evMan5.3 software is used for statistical processing. Finally, GRADE standard is used to classify the quality of evidence, and a summary table of results is made. The software used is GRADEprofiler3.6.. Results: a total of 553 articles were obtained by computer retrieval. The results of Meta analysis showed that laparoscopic catheterization was superior to traditional operation in controlling catheter displacement (OR 0.2295% CI 0.13 to 0.39; P0.00001, but slightly increased the risk of bleeding (OR 2.1395% CI 1.07 to 4.23; P = 0.03), but there was no significant difference in other catheter-related complications between the two groups. In addition, the catheter survival rate of laparoscopic catheterization was higher than that of conventional catheterization (1-year survival rate: OR 2.64%, 95% CI 1.69 to 4.14 P0.0001; 2-year survival rate: OR 2.1895% CI 1.48 to 3.21; P0.0001). The GRADE grade of the above results was only A grade for abdominal canal transposition, while the others were B or C grade. The overall quality of research is medium. Conclusion: in general, laparoscopic catheterization can reduce catheter displacement and improve catheter survival rate, but it will slightly increase the risk of bleeding. The overall quality of this study is moderate and needs further research support.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R459.5

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