Post-operative abdominal complications in Crohn's disease in the biological era: Systematic review and meta-analysis

AIM: To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn's disease(CD) comparing biological with no therapy.METHODS: Pub Med, Medline and Embase databases were searched to identify studies comparing postoperative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios(OR) and confidence intervals(CI) for each outcome measure of interest. RESULTS: A total of 14 studies were included for metaanalysis, comprising a total of 5425 patients with CD 1024(biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications(OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection(OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak(OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis(OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation(OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy. CONCLUSION: Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.     

梗阻性黄疸时脾切除对肠黏膜屏障影响的实验研究

目的 探讨脾脏在梗阻性黄疸(阻黄)中对肠黏膜屏障的作用及其机制.方法 50只Wistar大鼠随机分组,阻黄组开腹结扎胆总管;阻黄+脾切除组,同时切除脾脏.术后7d观察血浆内毒素水平的变化,用乳果糖/甘露醇(L/M)比值检测肠黏膜通透性;采用免疫组织化学、Western印迹检测末端回肠紧密连接蛋白闭锁小带-1(ZO-1)、闭锁蛋白的表达,并利用图像分析系统对Western印迹图像进行定量分析.结果 阻黄+脾切除后L/M的比值和血浆内毒素水平较阻黄组明显下降(均P=0.001).与阻黄组相比,阻黄+脾切除组的平均肠绒毛高度和隐窝深度有所上升(P=0.019、0.001).免疫组化显示术后7 d阻黄组ZO-1蛋白强阳性表达数(6/18)下降明显(P=0.021),阻黄+脾切除组(8/17)染色较阻黄组变化不大;闭锁蛋白的染色阻黄+脾切除组强阳性表达(7/17)高于阻黄组(4/18)(P=0.026).通过对Western印迹图像进行定量分析也得出同样的结论.结论 阻黄后肠黏膜通透性增加,肠黏膜屏障受损.同时切除脾脏,肠紧密连接蛋白成分的数量和分布改变,肠黏膜屏障的损害减轻.

Abstract：

Objective To investigate the effects of splenectomy on the intestine mucosa barrier in rats with obstructive jaundice. Methods 50 Wistar rats were divided randomly into the obstructive jaundice group (OJ), in which the animals underwent operation to ligate common bile duct, and the obstructive jaundice + splenectomy group (OJ+ S). Seven days post-operation, plasma endotoxin levels were detected. Intestinal mucosa permeability was measured by the ratios of lactulose and mannitol (L/M). Immunohistochemistry and Western blot were used to examine the expression of tight junction proteins (ZO-1 and occludin) in the distal ileum mucosa. Western blots images were analyzed quantitatively. Results Average ratios of L/M and plasma endotoxin were decreased obviously in the OJ+S group compared to those in the OJ group (all P=0. 001). Compared with the OJ group, the average intestinal villus height and mucosa thickness were upgraded somewhat in the OJ + S group (P = 0.019, 0. 001 ). By immunohistochemistry staining seven days post-operation, same comment as above the amounts of strong positive expression of ZO-1 were significantly decreased in the OJ group (6/18, P-0. 021). There wewas no difference between the OJ+S group(8/17) and the OJ group.The amount of strong positive expression of occludin was higher in the OJ + S group than that of the OJ group(10/17 vs 4/18, P= 0. 026). The same outcomes were obtained by quantitative Western blot images. Conclusion The intestinal epithelial permeability was increased in rats with obstructive jaundice,and intestinal barrier was damaged. After excising spleen, the amount and distribution of tight junction proteins were changed and the impairment of intestinal barrier was abated.     

Association of TCF7L2 mutation and atypical diabetes in a Uruguayan population

AIM To investigate if mutations in TCF7 L2 are associated with "atypical diabetes" in the Uruguayan population.METHODS Healthy, nondiabetic controls(n = 133) and patients with type 2 diabetes(n = 177) were selected from among the presenting population at level-3 referral healthcare centers in Uruguay. Patients with type 2 diabetes were subgrouped according to "atypical diabetes"(n = 92) and "classical diabetes"(n = 85). Genotyping for the rs12255372 and rs7903146 single nucleotide polymorphisms(SNPs) in the TCFTL2 gene was carried out with Taq Man? probes. Random samples were sequenced by Macrogen Ltd.(South Korea). Statistical analysis of the SNP data was carried out with the SNPStats online tool(http://bioinfo.iconcologia.net/SNPstats). The best inheritance model was chosen according to the lowest values of Akaike's information criterion and Bayesian information criterion. Differences between groups were determined by unpaired t-tests after checking the normal distribution or were converted to normalize the data. The association of SNPs was tested for matched case-control samples by using χ2 analysis and calculation of odds ratios(ORs) with 95% confidence intervals(CIs). All statistical tests were performed using SPSS v10.0 and EpiI nfo7 statistical packages. Significant statistical differences were assumed in all cases showing adjusted P 0.05.RESULTS We genotyped two TCF7 L2 SNPs(rs7903146 and rs12255372) in a population-based sample of 310 Uruguayan subjects, including 133 healthy control subjects and 177 clinical diagnosed with type 2 diabetes. For both SNPs analyzed, the best model was the dominant type: rs12255372 = G/G vs G/T+T/T, OR = 0.63, 95%CI: 0.40-0.98, P 0.05 and rs7903146 = C/C vs C/T+T/T, OR = 0.79, 95%CI: 0.41-1.55, P = 0.3. The rs12255372 SNP showed high association with the type 2 diabetes cases(OR = 1.60, 95%CI: 1.20-2.51, P 0.05). However, when the type 2 diabetics group was analyzed according to the atypical and classical subgroupings, the association with diabetes existed only for rs12255372 and the classical subgroup(vs controls: OR = 2.1, 95%CI: 1.21-3.75, P 0.05); no significant differences were found for either SNP or atypical diabetes.CONCLUSION This is the first time SNPs_TCF7 L2 were genotyped in a diabetic population stratified by genotype instead of phenotype. Classical and atypical patients showed statistical differences.     

选择性脾动脉栓塞术与传统开腹手术治疗外伤性脾破裂安全性和有效性的Meta分析

目的比较选择性脾动脉栓塞术（PSAE）与传统开腹手术（OS）治疗外伤性脾破裂的临床疗效。 方法检索中国知网、万方数据、维普数据库、PubMed、Web of Science、Embase数据库中关于PSAE和OS两种手术方式治疗外伤性脾破裂的相关文献，检索时间为建库至2022年5月31日。提取文献内数据，采用RevMan 5.3软件进行Meta分析。 结果最终纳入16篇文献共5 238例患者，其中PSAE组1 037例，OS组4 201例。Meta分析显示：相较于OS组，PSAE组术中出血量更少（WMD= -392.95，95% CI：-667.52，-118.38；P=0.005），术中输血量更少（WMD=-433.87，95% CI：-582.85，-284.89；P<0.000 01），手术时间更短（WMD=-60.25，95% CI：-71.99，-48.52；P<0.000 01），抢救成功率更高（WMD=4.00，95% CI：1.32，12.09；P=0.01），且PSAE组术后下床时间（WMD=-14.44，95% CI：-20.32，-8.55；P<0.000 01）和住院时间（WMD=-4.89，95% CI：-5.86，-3.91；P<0.000 01）更短；术后并发症发生率方面，PSAE组术后切口感染（OR=0.21，95% CI：0.11，0.37；P<0.000 01）、肠梗阻（OR=0.24，95% CI：0.10，0.55；P=0.000 8）、肺炎（OR=0.44，95% CI：0.32，0.61；P<0.000 01）的发生率均低于OS组，但两组术后脾脓肿、发热、腹腔积液的比较，差异无统计学意义；术后免疫功能恢复方面，PSAE组术后1个月的CD3⁺水平（WMD=9.27，95% CI：6.32，12.22；P<0.000 01）、CD4⁺水平（WMD=5.60，95% CI：3.86，7.34；P<0.000 01）、CD4⁺/CD8⁺值（WMD=0.35，95% CI：0.18，0.52；P<0.000 01）均高于OS组，但OS组术后1个月的CD8⁺水平高于PSAE组（WMD=-1.20，95% CI：-1.72，-0.68；P<0.000 01）。 结论在外伤性脾破裂患者的诊治中，PSAE较OS有其独到优势，具有操作简单、手术时间短、术中出血量少、术后并发症少、住院时间短、术后免疫功能恢复早等优势，值得临床选用。     

脾切除对活体肝移植术后肝脏血流动力学的影响

目的 研究活体肝移植联合脾脏切除术后患者肝脏血流动力学变化情况.方法 回顾性分析2006年8月至2009年3月开展的66例活体肝移植手术患者的病例资料,肝移植时行脾切除者共22例(脾切除组),年龄(45±11)岁,按1∶2的比例随机抽取同期具有可比性的肝移植时未行脾切除的44例患者作为对照组,年龄(44±10)岁,对比分析移植术后两组间患者肝脏血流动力学变化.结果 术前、术后1 d保留脾脏组和脾切除组门静脉血流速度分别为(12±2)cm/s和(11±3)cm/s、(35±18)cm/s和(32±17)cm/s,两组术后门静脉血流速度均显著大于术前水平(P＜0.05),术后1周两组肝右静脉血流速度分别为(44±18)cm/s和(31±15)cm/s,术后保留脾脏组肝右静脉血流速度明显大于脾切除组(P＜0.05),术后2周两组肝动脉血流速度分别为(18±8)cm/s和(26±7)cm/s,肝动脉阻力系数分别为0.66±0.13和0.57±0.12,1周后脾切除组肝动脉血流速度明显大于保留脾脏组(P＜0.05),而肝动脉阻力系数明显小于后者(P＜0.05).结论 活体肝移植联合脾切除术后肝脏的血流动力学情况优于单纯活体肝移植术式.

Abstract：

Objective To investigate the changes of hepatic hemodynamics in patients with splenectomy plus living donor liver transplantation (LDLT). Methods The data of 66 patients received LDLT from August 2006 to March 2009 were analyzed retrospectively:22 cases received splenectomy with LDLT (splenectomy group) and aged (45±11) years. Forty-four comparable cases received LDLT only in the mean time were selected as control group and aged (44±10) years. Comparative analysis was performed between the two groups with respect to the changes of hepatic hemodynamics after transplantation.Results Blood velocity in portal vein in control group and splenectomy group at 1 day before and after the transplantation were (12 ±2) cm/s vs. (11+3) cm/s, (35±18) cm/s vs. (32 ± 17) cm/s, respectively. Postoperative blood velocity in portal vein in both groups increased significantly than the preoperative level ( P ＜ 0.05).Blood flow velocity in right hepatic vein in both groups at 1 week after the treatment were (44±18)cm/s and (31±15) cm/s(P＜0.05), respectively. Blood flow velocity in hepatic artery in both groups 2 weeks after the operation were (18±8) cm/s vs. (26±7) cm/s(P＜0.05) and resistance coefficient of hepatic artery were 0.66±0.13 vs. 0.57±0.12 (P＜0.05), respectively. Conclusion Hepatic hemodynamics in patients received LDLT plus splenectomy is superior to that in patients received LDLT only.     

腹腔镜手术治疗直肠癌疗效的Meta分析

Objective To evaluate the clinical outcomes after laparoscopic surgery for rectal cancer.Methods A systematic literature search (Medline,Embase,Cochrane Library) as of March 2010 was performed to identify all eligible studies.Two reviewers independently screened and extracted the data.Differences in short-term and long-term clinical outcomes after laparoscopic resection (LR)and open resection (OR) were analyzed using RevMan 5.Results A total of 1042 abstracts were retrieved and 16 clinical controlled studies finally included.The total number of patients was 2850.There were 1145 patients received LR and 1705 received OR.The analyses showed that LR had longer operative time (WMD=42.50,95% CI:29.27 to 55.74,P＜0.05),less harvested lymph nodes (WMD=-0.94,95% CI:-1.47 to -0.41 ,P＜0.05),and less blood loss(WMD=-158.46,95% CI:-221.08 to -95.84,P＜0.05)as compared to OR.LR was superior to OR in terms of surgical mortality (OR=0.40,95% CI:0.18 to 0.92,P=0.03),postoperative complications (OR=0.73,95% CI:0.61 to 0.87,P＜0.05),and 5-year overall survival rate (OR=1.56,95% CI:1.21 to 2.02,P＜0.05).There was no significant difference in positive rate of circumferential resection margin between the two groups(OR=1.00,95% CI:0.45 to 2.20,P=1.00).Conclusion Compared to open surgery,short-term and longterm clinical outcomes after laparoscopic surgery are favorable.     

脾切除对肝纤维化大鼠肝脏PDGF-B表达及血清PDGF-BB水平的影响

Objective To explore the effects of splenectomy on hepatic fibrosis and on the expression of PDGF-B in the liver and PDGF-BB in the serum of rats with hepatic fibrosis. Methods By hypodermic injection CCl4, we established 65 rat models with hepatic fibrosis, splenectomies were performed in the three groups at different phases: before hypodermic injection CCl4 (A group), five weeks after hypodermic injection CCl4 (B group), and ten weeks hypodermic injection CCl4 (C group). The control groups were established at the same time, with samples of the livers and serum of the rats taken in different phases. The expressions of PDGF in the liver were detected by immunohistochemistry technique and the degree of hepatic fibrosis was detected by HE staining. The serum levels of PDGF-BB were analyzed by ELISA technique. Results Absorbance values of PDGF-B in the experimental group were significantly lower than the control groups (P＜0. 05). Serum levels of PDGF-BB of the rats after splenectomy were significantly lower than those in the control groups (P＜0.05). HE and Masson's staining showed that the progression of Hepatic fibrosis was slow in the A group. Hepatic pathologic state was significantly relieved in the B group and the inflammation and fibrosis was relieved in the C group. Conclusion Earlier period splenectomy could delay the proceeding of experimental hepatic fibrosis. After splenectomy the decline in the level of PDGF may be one of the mechanisms causing the delay.     

手助腹腔镜与开腹脾切除、贲门周围血管离断术的临床分析

Objective To investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. Methods The clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. Results There was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. Conclusions Compared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.     

腹主动脉瘤开腹手术与腔内修复术围手术期情况的荟萃分析

目的 评价国内腹主动脉瘤(AAA)开腹手术与腔内修复术围手术期情况.方法 检索2000年1月-2009年1月国内临床中心以中英文公开发表的AAA开腹手术与腔内修复术围手术期情况的非随机对照(NRCs)研究文献,提取相关指标后综合分析.结果 6篇NRCs资料质量评分为18.83±0.98.与开腹手术相比,腔内修复术术中失血量(WMD=-689.24 mL,95%CI为-1 077.61～-300.88,P＜0.05),术中输血量(WMD=-440.01 mL,95%CI为-488.96～-391.06,P＜0.05),术后禁食时间(WMD=-5.21 d,95% CI 为-6.23～-4.19,P＜0.05),术后ICU观察时间(WMD=-1.79 d,95% CI 为-2.21～-1.46,P＜0.05),术后住院时间(WMD:-5.19 d,95% CI 为-7.09～-3.28,P＜0.05)均显著减少.两种治疗方法 的手术时间(WMD=-35.86 min,95% CI 为-85.01～1 3.28,P=0.15)及并发症发生率(OR=0.92,95% CI 为0.55～1.53,P=0.74)差异无统计学意义.结论 国内NRCs资料的荟萃分析显示,腔内修复治疗AAA较开腹手术具有创伤小、失血少、术后恢复快的优点,但在手术时间及减少近期并发症方面无显著优势.     

我国腹腔镜和常规肝切除治疗原发性肝细胞肝癌近期及远期疗效比较的 META 分析

目的：系统评价国内腹腔镜与开腹手术切除治疗肝癌的近期及远期疗效。方法：计算机检索ISl WebofKnowledge、MEDLINE、EMbase、PubMed,万方数据库、中国知网、维普资讯,收集国内研究机构完成的腹腔镜切除与开暖切除比较治疗肝癌的对照试验。数据提取和文献质量评价由2名评价员独立进行。采用RevMan5.2对数据进行统计分析。结果：末获得随机对照试验,共纳入10个国内临床同期对照试验,累计病例552例。Meta分析结果显示：1）腹腔镜肝癌切除安全性更佳。可有效减少出血量[WMD=-83.3,95％CI（-124.3,-42.3）,P〈O0001]减少肝门阻断的使用[OR=0.17,95％CI（0.06,0.52）,P=O002],减少术后并发症的发生[OR=0.3,95％CI（0.16,0.59）,P=O.0004],明显缩短住院时间[WMD=-4.85,95％CI（-6.31,-3.38）,P〈O.00001]。2）腹腔镜肝癌切除远期疗效无不良影响。腹腔镜与开腹手术组间的肿瘤复发率[OR=1.05,95％Cl（0.6,1.85）,P=0.87]及1、3、5年总体生存率[OR=1.40,95％CI（0.76,256）,P=0.28;OR=1.15,95％Cl（0.74,1.81）,P=0.53;OR=0.91,95％CI（0.57,1.45）,P=0.68]和1、3年无瘤生存率[OR=I.89,95％CI（0.96,3.7）,P=0.16;OR=I57,95％CI（0.94,2.6t）,P=O18]差异无统计学意义（P〉O.05）。结论：对于病变位于Couinaud Ⅱ、Ⅲ、IV、V及VI段,肿瘤直径〈10cm,肝功能在Child B级以上的肝细胞癌患者,腹腔镜肝切除术对长期疗效无不良影响,且近期疗效更佳。     

胃切除术后留置胃肠减压必要性的Meta分析

目的 评价胃切除术后留置胃肠减压的必要性.方法 以Medline、Embase、the Cochrane Library数据库作为已发表国外文献的主要来源,以万方数据知识服务平台和中国知网数据出版平台作为已发表国内文献的主要来源;检索时间:2011年4月20日.收集1990-2011年公开发表的有关胃切除术后放置胃肠减压必要性的中文和英文文献.结果 筛选出符合纳入标准的前瞻性随机对照试验8项(975例).减压组和非减压组在术后排气时间相比差异无统计学意义(WMD=0.31,95%CI:-0.07～0.69,P＞0.05),而在进食时间和住院时间相比差异有统计学意义(WMD=0.61,95%CI:0.17～1.05,P＜0.05;WMD=1.20,95%CI:0.05～2.36,P＜0.05),非减压组的进食时间、住院时间短于减压组;减压组和非减压组发热的发生率之间相比差异有统计学意义(OR=1.76,95%CI:1.11～2.78,P＜0.05),减压组的发热发生率高于非减压组;其他并发症包括恶心、呕吐、肺部感染、吻合口瘘或十二指肠残端瘘、腹腔脓肿、切口裂开的发生率之间相比差异均无统计学意义(OR=1.43,95%CI:0.61～3.31,P＞0.05;OR=1.43,95%CI:0.82～2.49,P＞0.05;OR=1.17,95%CI:0.54～2.49,P＞0.05;OR=1.08,95%CI:0.50～2.34,P＞0.05;OR=1.47,95%CI:0.43～4.95,P＞0.05).结论 胃切除术后常规留置胃肠减压并不能加快胃肠功能的恢复,不能减少手术后并发症的发生,甚至增加术后发热的发生率,延长住院周期.     

肝癌合并肝硬化脾功能亢进的围手术期处理

目的 探讨肝癌联合脾切除对原发性肝癌合并肝硬化脾功能亢进患者手术安全性的影响以及围手术期处理原则.方法 回顾性分析1999年1月至2009年12月收治的177例原发性肝癌合并肝硬化脾功能亢进患者的临床资料,男性150例,女性27例,年龄25～76岁,平均(55±12)岁.按照是否联合脾切除术,将患者分为切脾组(n=71)和不切脾组(n=106).比较两组在手术安全性、术后并发症发生率、术后肝功能恢复、术后白细胞计数和血小板计数方面的差异.结果 两组患者术前一般情况及白细胞计数和血小板计数的差异无统计学意义(P＞0.05).切脾组术后第1、10、30天血小板计数分别为(88.4±23.6)×109/L、(345.3±98.2)×109/L、(210.8±92.2)×109/L,与不切脾组相比差异有统计学意义(P＜0.05).切脾组手术时间为(216±105)min,高于不切脾组的(135±60)min,差异有统计学意义(P＜0.05),但两组术中出血量及输血的差异无统计学意义.切脾组术后并发症发生率为11.3%,与不切脾组的6.6%相比差异无统计学意义.结论 只要严格掌握适应证,提高围手术期处理水平,肝癌合并肝硬化脾功能亢进患者行肝脾联合切除术是安全的.     

Use of hepatectomy and splenectomy to treat hepatocellular carcinoma with cirrhotic hypersplenism

BACKGROUND: The aim of this study was to compare the outcome after simultaneous hepatectomy and splenectomy with that after hepatectomy alone for hepatocellular carcinoma with associated hypersplenism. METHODS: Two hundred and four patients with hepatocellular carcinoma and cirrhotic hypersplenism were divided non-randomly into two groups. Ninety-four underwent simultaneous hepatectomy and splenectomy and 110 underwent hepatectomy alone. White blood cell (WBC) and platelet counts, total serum bilirubin levels, immune function, incidence of complications and 5-year survival rates in the two groups were compared. RESULTS: WBC and platelet counts, distribution of T cell subsets, and levels of bilirubin, interferon gamma and interleukin 2 were different between the two groups after operation. All patients who underwent hepatectomy and splenectomy but only 15.5 per cent of those who had hepatectomy alone completed adjuvant chemotherapy. The 5-year tumour-free survival rate was significantly higher after hepatectomy and splenectomy than after hepatectomy alone (37 versus 27.3 per cent; P = 0.003), although overall survival rates were similar. CONCLUSION: Simultaneous hepatectomy and splenectomy was associated with improved 5-year tumour-free survival in patients with hepatocellular carcinoma and hypersplenism.     

单束与双束解剖重建前交叉韧带临床疗效的荟萃分析

目的 通过荟萃分析评价单束与双束重建前交叉韧带在恢复膝关节前直向、旋转稳定性及膝关节功能评分方面的临床疗效,为前交叉韧带重建方法的选择提供依据.方法 计算机检索Ovid Medline和Pubmed、Embase、Cochrane图书馆、中国生物医学文献数据库、维普中文科技期刊数据库关于单束和双束解剖重建前交叉韧带的临床随机对照研究.阅读评价文献质量并提取有效数据,采用RevMan 5.0.23软件进行统计分析,两种手术方法的KT测量值、Lysholm评分采用加权均数差评价,轴移试验及国际膝关节文献委员会(IKDC)分级评分采用优势比评价.结果 共纳入前瞻性临床随机对照研究8篇.荟萃分析结果显示两种重建交叉韧带方法KT测量值差异具有统计学意义,加权均数差值-0.35 mm[95%CI(-0.61～0.08),P=0.01],但差异不具有临床意义;轴移试验合并优势比1.64[95%CI(0.85～3.16),P=0.14];IKDC分级评分优势比1.80[95%CI(0.98～3.31),P=0.06);Lysholm评分加权均数差值-1.91[95%CI(-3.45～0.37),P=0.01],差异有统计学意义.结论 双束解剖重建前交叉韧带的近期临床疗效不优于单束重建.     

��ǻ���뿪�������г���λֱ����������Լ�����г�Meta����

??Laparoscopic intersphincteric resection versus open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom??A Meta-analysis LI Chang-rong??LI Wei-feng??LI Hong-lang. Department of Gastrointestinal Surgery??the Second Affiliated Hospital of Nanchang University??Nanchang330006??China
Corresponding author??LI Hong-lang??E-mail??lihonglang6802@163.com
Abstract Objective To compare the clinical safety and efficacy of laparoscopic intersphincteric resection versus open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom. Methods Studies comparing laparoscopic intersphincteric resection with open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinoma were retreived from PubMed??Medline??Ovid??China National Knowledge Infrastructure (CNKI) and Wanfang databases by 2014. The methodological quality of the selected studies was assessed to determine studies suitable for inclusion. Meta-analysis was performed by fixed or random effects model. Results Ten observational studies with a total of 939 patients (501 patients in laparoscopic surgery groups and 438 patients in open surgery groups) were identified. Compared with open surgery group??laparoscopic surgical operation time extended??WMD=36.28??95%CI 4.30—68.26??P<0.05????intraoperative bleeding reduced (WMD=-95.84??95%CI -123.64—-68.03??P??0.01)??time of bowel function recovering??WMD=-1.05??95%CI -1.70—-0.41??P<0.01????normal dieting (WMD=-0.95??95%CI -1.34—-0.55??P<0.01) and hospital staying (WMD=-2.43??95%CI -3.95—-0.92??P<0.01) shortened respectively. Incidence of overall postoperative complication??OR=0.60??95%CI 0.44—0.84??P<0.01????positiving circumferential resection margin (OR=2.49??95%CI 1.12—5.54??P<0.05) and wound infection??OR=0.20??95%CI 0.07—0.60??P<0.01?? reduced respectively. No statistically significant difference was found on the local recurrence rate??distant metastasis??anastomotic leakage??postoperative intestinal obstruction between the two groups (P>0.05). Conclusion Laparoscopic-assisted intersphincteric resection is a technically feasible and safe alternative to open surgery with better short-term and long-term postoperative outcomes for ultralow rectal carcinoma.     

达芬奇机器人与腹腔镜手术行右半结肠切除术安全性及有效性的Meta分析

目的探讨达芬奇机器人与腹腔镜手术在右半结肠切除术中的安全性及有效性。方法检索Embase、Medline、Web of Science、中国知网及万方等数据库中2009年12月至今发表的有关右半结肠切除术的相关文献,使用Jadad评分及NOS评分评价文献质量,并使用Revman(5.3版)软件进行Meta分析。结果经过筛选纳入21篇文献,共计样本11648例,其中机器人组1523例,腹腔镜组10125例。Meta分析显示:在手术相关指标上,机器人组相比腹腔镜组手术时间更长[WMD=40.37,95%CI(28.88,51.86),P<0.01],但淋巴结清扫数更多[WMD=2.01,95%CI(0.59,3.44),P<0.01],中转开腹率更低[OR=0.31,95%CI(0.11,0.86),P=0.02],二者术中出血量无显著差异。在围手术期相关指标上,机器人组住院时间更短[WMD=-0.80,95%CI(-1.21,-0.39),P<0.01],肠道恢复更快[WMD=-0.43,95%CI(-0.70,-0.15),P<0.01],但费用比腹腔镜组显著提高。二者术后死亡率及并发症发生率差异无统计学意义。但机器人组伤口感染率[OR=0.66,95%CI(0.45,0.97),P=0.03]及吻合口瘘发生率[OR=0.37,95%CI(0.19,0.71),P<0.01]更低。结论达芬奇机器人行右半结肠切除术尽管手术时间较长,但术后恢复更快,淋巴清扫更彻底,伤口感染及吻合口瘘发生率更低。术后生活质量及预后资料较少,仍需开展高质量、大样本、多中心随机对照研究进行评价。     

腹腔镜直肠癌前切除术中保留左结肠动脉与否的Meta分析

目的系统评价腹腔镜直肠癌前切除术中保留左结肠动脉是否安全有效。 方法检索PubMed、EMBase、Cochrane图书馆、Sinomed、万方、维普、中国知网等数据库,文献检索起止时间均从建库至2018年2月。对纳入文献进行质量评价和数据提取,应用Revman 5.3软件进行Meta分析。 结果共纳入12篇文献1 863例患者,其中高位结扎（HT）组937例,低位结扎（LT）组926例。与HT组相比,LT组吻合口瘘发生率（OR=2.77,95%CI=1.73~4.42,P<0.001）、游离脾曲（OR=13.00,95%CI=3.90~43.37,P<0.001）及预防性回肠造口（OR=2.29,95%CI=1.55~3.38,P<0.001）均下降;两组肠系膜下动脉根部淋巴结清扫数（WMD=0.03,95%CI= -0.14~0.21,P=0.69）、总淋巴结清扫数（WMD=0.40,95%CI= 0~0.80,P=0.05）及复发转移率（OR=0.96,95%CI= 0.68~1.35,P=0.79）差异无统计学意义。HT组手术时间短于LT组（WMD=-7.06,95%CI= -10.75~-3.36,P<0.001）。 结论腹腔镜直肠癌前切除术中低位结扎肠系膜下动脉,在吻合口瘘等近期疗效指标有获益,但在复发转移无获益。     

Analysis of risk factors of severe hypocalcemia after total parathyroidectomy

Objective To analyze the incidence and risk factors of hypocalcemia after total parathyroidectomy without autotransplantation. Methods A total of 783 maintenance hemodialysis patients who underwent TPTX in the Second Affiliated Hospital of Nanjing Medical University from September 2008 to September 2017 were included in the study. The preoperative blood biochemical examination, preoperative iPTH, total mass of parathyroid gland (M) and postoperative iPTH and electrolyte results were collected. The incidence of severe hypocalcemia after TPTX were analyzed retrospectively. Binary logistic regression model was used to analyze the risk factors of severe hypocalcemia after TPTX. Results The age of 783 patients with TPTX was (46.90±10.78) years old, and the average dialysis age was (91.36±41.75) months. Postoperative severe hypocalcemia occurred in 235 cases (30.01%). Binary logistic regression analysis showed that higher preoperative blood iPTH (OR=7.56, 95%CI: 1.55-36.79, P=0.01), higher blood alkaline phosphatase (OR=36.71, 95%CI: 14.75-91.36, P＜0.01), blood phosphorus (OR=1.74, 95%CI: 1.11-2.71, P=0.02) and greater mass of resected glands (OR=1.18, 95% CI: 1.06-1.31, P＜0.01) were the risk factors for post-hypocalcemia. The higher preoperative serum calcium can reduce the risk of postoperative hypocalcemia (OR=0.02, 95%CI: 0.01-0.07, P＜0.01). Conclusions The incidence of hypocalcemia after TPTX treatment for SHPT is very high. Blood iPTH, alkaline phosphatase, phosphorus, and total mass of intraoperative parathyroid gland excision are the independent risk factors for severe hypocalcemia after surgery.