發(fā)布時(shí)間：2018-01-27 11:14

  本文關(guān)鍵詞： 腹腔鏡膽總管探查術(shù) 一期縫合 T管引流 Meta分析　出處：《昆明醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的]通過(guò)meta分析方法,對(duì)腹腔鏡膽總管探查(Laparoscopic common bile duct exploration, LCBDE)取石后膽管一期縫合(Primary closure, PC)與T管引流(T-tube drainage, TD)治療肝外膽管結(jié)石近期臨床療效進(jìn)行分析評(píng)價(jià)。[方法]通過(guò)計(jì)算機(jī)檢索CHKD中國(guó)醫(yī)院知識(shí)倉(cāng)庫(kù)、PubMed、CBM生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、萬(wàn)方醫(yī)學(xué)網(wǎng)、FMJS外文全文獲取系統(tǒng)、FEBM循證醫(yī)學(xué)外文數(shù)據(jù)庫(kù)上2005年至2015年12月發(fā)表的,并追索納入文獻(xiàn)的參考文獻(xiàn),查找國(guó)內(nèi)外關(guān)于腹腔鏡膽總管探查膽管一期縫合與T管引流的臨床病例對(duì)照研究文獻(xiàn)。根據(jù)納入與排除標(biāo)準(zhǔn)對(duì)文獻(xiàn)進(jìn)行篩選,并對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià),提取其中手術(shù)時(shí)間、術(shù)中出血量、胃腸道功能恢復(fù)時(shí)間、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥(包括膽漏、膽道殘石、膽道狹窄、膽汁性腹膜炎、切口感染等)的具體數(shù)據(jù)。采用Cochrane協(xié)作網(wǎng)提供的RevMan5.3統(tǒng)計(jì)學(xué)軟件進(jìn)行Meta分析。[結(jié)果]按照納入標(biāo)準(zhǔn),有6項(xiàng)臨床試驗(yàn)共769病例納入研究。Meta分析結(jié)果顯示,一期縫合組與T管引流組相比較,在手術(shù)時(shí)間(WMD 95%CI,-17.44[-27.83,-7.06],P=0.0010)、術(shù)中出血量(WMD 95%CI,-0.54[-0.97,-0.10],P=0.02)、術(shù)后住院時(shí)間(WMD 95%CI,-3.06[-3.23,-2.89],P0.00001)、胃腸道功能恢復(fù)時(shí)間(WMD 95%C1,-14.00[-20.90,-7.09],P0.0001)方面有統(tǒng)計(jì)學(xué)意義,在術(shù)后并發(fā)癥膽漏(OR=I.15,95%CI：0.54～2.44,P=0.72)、膽道殘石(OR=0.79,95%CI：0.33～1.89,P=0.60)、膽道狹窄(OR=0.58,95%CI：0.08～4.53,P=0.61)、膽汁性腹膜炎(OR=0.22,95%CI：0.04～1.30,P=0.10)、切口感染(OR=0.25,95%CI：0.04～1.53,P=0.13)方面兩組結(jié)果無(wú)統(tǒng)計(jì)學(xué)意義。[結(jié)論]從本組的資料看來(lái),腹腔鏡下膽總管探查術(shù)膽道一期縫合能減少手術(shù)時(shí)間、減少術(shù)中出血量、縮短術(shù)后患者胃腸道功能恢復(fù)時(shí)間和住院時(shí)間,比T管引流有優(yōu)勢(shì),而在術(shù)后并發(fā)癥(包括膽漏、膽道殘石、膽道狹窄、膽汁性腹膜炎、切口感染等)方面兩者之間無(wú)統(tǒng)計(jì)學(xué)意義,故腹腔鏡下膽總管探查膽管一期縫合術(shù)有推廣應(yīng)用的價(jià)值。但由于納入本研究的多樣本偏低,納入的文獻(xiàn)質(zhì)量有限,尚缺乏多中心隨機(jī)對(duì)照試驗(yàn),有待更多合理嚴(yán)謹(jǐn)?shù)亩嘀行拇髽颖倦S機(jī)對(duì)照試驗(yàn)進(jìn)一步驗(yàn)證。
[Abstract]:[Objective] to investigate the laparoscopic common bile duct exploration by meta. Primary closure (PCL) and T-tube drainage were performed after primary suture of bile duct after lithotomy. The clinical effect of TD on extrahepatic cholelithiasis was analyzed and evaluated. [Methods: the CHKD Chinese Hospital knowledge Warehouse (CHKD) was searched by computer to retrieve the CBM biomedical literature database, and the full text acquisition system of FMJS was used in Wanfang Medical Network. FEBM Evidence-based Medicine Foreign language Database was published from 2005 to December 2015. To find domestic and foreign literature on laparoscopic choledochus exploration bile duct primary suture and T-tube drainage clinical case-control study. According to the inclusion and exclusion criteria to screen the literature and to evaluate the quality of the included literature. Extraction of the operation time, intraoperative bleeding, gastrointestinal function recovery time, postoperative hospital time, postoperative complications (including bile leakage, biliary remnant stone, biliary stricture, biliary peritonitis). The specific data of incision infection were analyzed by RevMan5.3 software provided by Cochrane Cooperative Network. [Results: according to the inclusion criteria, 769 cases of 6 clinical trials were included in the study. The results of meta-analysis showed that compared with T-tube drainage group, the primary suture group had WMD 95CI in the operation time. -17.44. [-27.83% -7.06] (P < 0.0010), intraoperative bleeding volume: WMD 95: CI-0.54. [After operation, the hospital stay was longer than WMD 95 and CI-3.06. [P0.00001, Gastrointestinal function recovery time: WMD 95 / -14.00. [There was statistical significance in the postoperative complications, ORI.151.95 CI: 0.54 / 2.44 (P = 0.0001, P = 0.0001, P = 0.090, P = 7.09, P = 0.0001, P = 0.54, P = 0.0001, P = 0.0001). P0. 72%, Bile duct Stones were 0. 79 + 95% CI: 0. 33, 1. 89, P0. 60, and 0. 58 for stricture of bile duct. 95 CI: 0.08% 4.53% P0. 61, bile peritonitis 0.22% 0. 22% 0. 95% 1. 30% P0. 10). There was no significant difference between the two groups in the two groups. [Conclusion: according to the data of this group, the primary suture of common bile duct exploration under laparoscope can reduce the operation time, reduce the amount of intraoperative bleeding, shorten the postoperative gastrointestinal function recovery time and hospitalization time. There was no significant difference in postoperative complications (including bile leakage, biliary remnant stone, biliary stricture, biliary peritonitis, incision infection, etc.). Therefore laparoscopic choledochus exploration for primary suture of bile duct has the value of popularization but due to the low number of samples included in this study and the limited quality of the literature there is still a lack of multicenter randomized controlled trial. More reasonable and rigorous randomized controlled trials of large-scale multi-center samples are needed to be further verified.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R657.42

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 林云志;李治敏;宋創(chuàng)鋒;;T管拔管后致膽汁性腹膜炎11例的處理體會(huì)[J];海南醫(yī)學(xué);2007年09期

2 李勇;梁久銀;孫家忠;李婧;王濤;;腹腔鏡膽總管探查拔T管后膽漏及處理(附3例報(bào)導(dǎo))[J];肝膽外科雜志;2010年04期

3 鄭偉;陳涵;徐偉;何宗富;;腹腔鏡膽總管探查T管引流術(shù)的臨床體會(huì)[J];中外醫(yī)學(xué)研究;2013年04期

4 朱琪;拔除T管后膽汁性腹膜炎6例分析[J];上海醫(yī)科大學(xué)學(xué)報(bào);1996年02期

5 史皖慶，，吳珙樂(lè);拔除T管引起膽汁性腹膜炎的預(yù)防[J];河北醫(yī)學(xué);1996年05期

6 劉志偉,臧國(guó)輝;膽總管切開(kāi)取石術(shù)后早期夾閉T管的臨床意義[J];衡陽(yáng)醫(yī)學(xué)院學(xué)報(bào)(醫(yī)學(xué)版);2000年03期

7 黃紹新;拔T管致膽汁性腹膜炎9例分析[J];蘇州醫(yī)學(xué)院學(xué)報(bào);2000年11期

8 李成勛,徐曉梅;T管拔除后膽汁性腹膜炎3例教訓(xùn)分析[J];四川醫(yī)學(xué);2001年12期

9 謝小軍;T管拔除后膽汁性腹膜炎19例分析[J];浙江實(shí)用醫(yī)學(xué);2001年01期

10 郭紹紅,董集生;腹腔鏡膽總管切開(kāi)探查專用T管送入器的研制和應(yīng)用[J];中國(guó)微創(chuàng)外科雜志;2001年03期

相關(guān)重要報(bào)紙文章 前1條

1 李宇溪　藍(lán)玨 記者 洪泉;“六T管理法”力推廣西餐飲安全[N];中國(guó)食品安全報(bào);2012年

相關(guān)碩士學(xué)位論文 前5條

1 SUBRATA BARUA;腹腔鏡膽總管探查與T管引流[D];山東大學(xué);2016年

2 殷劍雄;腹腔鏡下膽總管探查膽管一期縫合與T管引流近期臨床療效對(duì)比的meta分析[D];昆明醫(yī)科大學(xué);2016年

3 何成周;腹腔鏡膽總管切開(kāi)T管引流術(shù)在80歲以上高齡患者的應(yīng)用[D];福建醫(yī)科大學(xué);2013年

4 肖林糠;腹腔鏡膽總管探查膽管一期縫合與T管引流的Meta分析[D];重慶醫(yī)科大學(xué);2013年

5 王聰;腔鏡經(jīng)膽囊管膽道探查與T管引流治療膽總管結(jié)石的比較[D];新疆醫(yī)科大學(xué);2014年

本文編號(hào)：1468337