本文選題：膽囊切除 + 大腸癌��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:通過Meta分析評價膽囊切除和大腸癌的關系,以便于指導臨床,早期篩查,預防大腸癌的發(fā)生。研究方法:檢索中文生物醫(yī)學文獻數(shù)據(jù)庫(CBM)、相關期刊論文(China national knowledge infrastructure,CNKI)、萬方數(shù)據(jù)庫、維普數(shù)據(jù)庫(VBM)、PubMed、EMBASE、Web of Science、Cochrane Library等數(shù)據(jù)庫,時間自建庫起截止至2016年10月31日,收集國內外公開發(fā)表的有關膽囊切除與大腸癌關系的文獻。納入涉及膽囊切除與大腸癌關系的病例對照研究或前瞻性隊列研究文獻。用Stata 13.0軟件進行Meta分析。病例對照研究中,將OR值及其95%可信區(qū)間(95%CI)進行合并,前瞻性隊列研究中,將RR值及其95%可信區(qū)間(95%CI)進行合并,分析膽囊切除與大腸癌的關系。結果:嚴格按照文獻納入標準及排除標準,共納入61篇文獻,其中病例對照研究56篇,前瞻性隊列研究5篇。1.病例對照研究(1)總研究對象的Meta分析膽囊切除與大腸癌發(fā)生有關,且其能夠促進大腸癌的發(fā)生[OR=1.58,95%CI 1.39-1.79,P=0.000]。(2)亞組分析1)性別病例對照研究顯示女性患者行膽囊切除術后患大腸癌的風險增加[OR=1.30,95%CI 1.07-1.58,P=0.009],而膽囊切除不會增加男性患者患大腸癌的風險[OR=1.14,95%CI 0.93-1.40,P=0.195]。2)腫瘤部位膽囊切除能夠促進結腸癌尤其是右半結腸癌的發(fā)生(結腸癌:[OR=1.40,95%CI 1.18-1.65,P=0.000],右半結腸癌:[OR=2.17,95%CI 1.40-3.38,P=0.001]),與直腸癌及左半結腸癌的發(fā)生無關(直腸癌:[OR=0.88,95%CI 0.74-1.04,P=0.143],左半結腸癌:[OR=1.02,95%CI 0.76-1.37,P=0.901])。3)對照組人群以醫(yī)院人群為對照組的研究提示膽囊切除會增加大腸癌發(fā)生的風險[OR=1.92,95%CI 1.62-2.26,P=0.000],以社區(qū)人群為對照組的研究提示膽囊切除術后患者患大腸癌的風險無增加[OR=1.03,95%CI 0.88-1.22,P=0.701]。4)地區(qū)膽囊切除能夠增加歐洲及亞洲地區(qū)人群大腸癌的發(fā)病率(歐洲:[OR=1.37,95%CI 1.06-1.77,P=0.015];亞洲:[OR=2.35,95%CI 1.89-2.90,P=0.000]),但不能夠增加大洋洲以及北美洲地區(qū)大腸癌的發(fā)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]),且亞洲地區(qū)膽囊切除與大腸癌的發(fā)生有顯著相關性。2.前瞻性隊列研究前瞻性隊列研究顯示膽囊切除不會增加男性及女性患者患大腸癌的風險(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])。結論:1.膽囊切除術可能會促進大腸癌的發(fā)生。2.膽囊切除可能增加女性患者患右半結腸癌的風險。3.膽囊切除能夠增加亞洲及歐洲地區(qū)患者患大腸癌的風險,其中亞洲地區(qū)人群行膽囊切除術后更易患大腸癌。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.34;R657.4

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