腔内修复术与开腹手术治疗腹主动脉瘤围手术期疗效的Meta分析

目的：系统评价方法比较血管腔内修复术与开腹术手术治疗腹主动脉瘤（AAA）的围手术期疗效。方法：检索国内外文献数据库,收集血管腔内修复术与开腹术手术治疗AAA的随机对照试验,采用RevMan5.1软件进行Meta分析。结果：共纳入7个随机对照试验,8篇文献,共2 807例患者,其中行血管腔内修复术1?433例（腔内组）,开腹手术1 374例（开腹组）。Meta分析结果显示,腔内组较开腹组手术时间减少（SMD=-0.87,95% CI=-1.43--0.31,P=0.002）,术中输血量减少（SMD=-0.83,95% CI=-0.94--0.72,P<0.00001）,ICU监护时间缩短（MD=-38.11,95% CI=-48.61--27.61,P<0.00001）,术后住院时间缩短（MD=-5.11,95% CI=-6.26--3.95,P<0.00001）,术后30 d病死例数降低（OR=0.30,95% CI=0.16-0.55,P=0.0001）。结论：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,围手术期具有较大优势,但长期预后有待研究。

     

腹腔镜辅助根治性全胃切除术的Meta分析

目的 从循证医学角度评价腹腔镜辅助根治性全胃切除术的安全性和有效性.方法 检索2012年2月以前公开发表的对比腹腔镜辅助根治性全胃切除术(LATG组)和开腹根治性全胃切除术(OTG组)的文献.按纳入标准筛选后进行质量评分,提取临床效应指标,采用RevMan 5.1软件对所纳入的数据进行荟萃分析.结果 本研究共纳入10个对照试验,样本总量942例,其中LATG组422例,OTG组520例.荟萃分析结果显示,与OTG组相比,LATG组手术时间长(WMD=41.12 min,95％CI:20.62 ～ 61.63,P＜0.01),术中失血量少(WMD=-198.36 ml,95％ CI:-300.94～-95.78,P＜0.01),术后肛门排气时间早(WMD=-0.80d,95％ CI:-1.17 ～-0.42,P＜0.01),总体并发症少(RR =0.55,95％ CI:0.40～0.76,P＜0.01),术后住院时间短(WMD=-4.02 d,95％ CI:-6.03 ～-2.01,P＜0.01).两组淋巴结清扫数目、切缘距离及死亡率之间相比差异均无统计学意义(P＞0.05).结论 腹腔镜辅助根治性全胃切除术安全可行,具有术中出血少、术后恢复快和并发症少等优点.     

腹腔镜与开放手术治疗胆总管囊肿临床效果的Meta分析

目的：通过Meta分析的方法比较腹腔镜与开腹手术治疗先天性胆总管囊肿的有效性和安全性。 方法：检索国内外数据库中有关腹腔镜与开腹手术治疗小儿胆总管囊肿效果的回顾性分析或病例对照研究,再根据制定的标准筛选文献行Meta分析。 结果：最终纳入10篇文献,共1?394例患者,其中589例行腹腔镜手术（腹腔镜组）,805例行开腹手术（开腹组）。与开腹组比较,腹腔镜组手术时间延长（WMD=54.51,95% CI=24.37~84.64,P<0.05）;术中失血量减少（WMD=-16.27,95% CI=-21.16~-11.39,P<0.05）;术后首次排气时间、进食时间缩短（WMD=-1.2,95% CI=-1.22~-1.18;WMD=-1.31,95% CI=-1.62~-1.00,均P<0.05）;术后住院时间与并发症发生率减少（WMD=-3.04,95% CI=-4.08~-2.36;OR=0.37,95% CI=0.15~0.90,均P<0.05）。 结论：腹腔镜手术相对于开腹手术治疗胆总管囊肿具有明显的优势;随着腹腔镜技术与术者水平的不断提高,腹腔镜手术将成为治疗胆总管囊肿首选术式。     

腹腔镜结直肠癌手术疗效及安全性的系统评价

目的 系统评价腹腔镜与开腹手术切除治疗结直肠癌的疗效及安全性.方法 采用Cochrane系统评价方法,检索Embase、PubMed、Cochrane图书馆、Sciencedirect、Springer、VIP、CNKI、CBMdisc等数据库中2000年1月至2010年10月公开发表的腹腔镜与开腹手术切除治疗结直肠癌的随机对照试验(RCT),对符合纳入标准的研究进行质量评价和资料提取,并采用RevMan 5.0对腹腔镜与开腹手术切除治疗结直肠癌的疗效及安全性进行meta分析.结果 共纳入13项RCT,共计4603例患者.其中6项为多中心RCT.meta分析结果显示:腹腔镜组手术时间长于开腹组(加权均数差值WMD=38.91,95% CI:33.89～43.93,P＜0.001),术中失血量少于开腹组(WMD=-138.14,95% CI:-195.79～-80.50,P＜0.001),总住院时间少于开腹组(WMD=2.91,95%CI:-4.65～-1.17,P=0.001);两组淋巴结清扫数量、术后并发症(30 d)发生率、3年总生存率、5年总生存率、5年总复发率的差异均无统计学意义(均为P＞0.05).结论 腹腔镜辅助下行结直肠癌根治术的短期和长期结果均表明其有效并且安全,有望成为结直肠癌治疗的新选择.

Abstract：

Objective To evaluate and compare the efficiency and safety of laparoscopic surgery (LS) and open surgery (OS) in the treatment of colorectal carcinoma. Methods Randomized controlled trials on laparoscopic surgery and open surgery for colorectal carcinoma from January 2000 to October 2010were searched in the databases of EMbase, PubMed, Cochrane Library, Sciencedirect, Springer, VIP,CNKI, CBMdisc. The methodological quality was assessed according to the standard of Cochrane systematic review. For homogeneous studies, RevMan5.0 software was used for meta-analysis. Results A total of 13 RCTs involving 4603 patients were included in this study, and among those 6 were multi-center randomized controlled trials. The meta-analysis showed that: the operation time of the LS group was longer than that of the OS group ( WMD = 38. 91, 95% CI: 33.89-43.93, P ＜ 0. 001 ), the blood loss ( WMD =- 138. 14, 95% CI:-195. 79-80. 50, P ＜ 0. 001 ) and the length of hospital stay ( WMD = 2. 91, 95%CI: -4. 65-1.17, P =0. 001 ) of the LS group was less than those in OS group. There was no significant differences between the two groups in the number of dissected lymph nodes( WMD = -0. 62, 95% CI:- 1.47-0. 23, P = 0.150). There was no significant differences between the two groups in terms of the postoperative complications(30 days) (RR =0.78,95% CI:0. 59-1.01, P = 0. 06 ). There was no significant differences between the two groups in 3-year overall survival ( RR = 1.00, 95% CI :0. 96-1.04, P = 0. 970).There was no significant differences between the two groups in 5-year overall survival (RR = 1.03, 95% CI:0. 99-1.08, P = 0. 140 ). There was no significant differences between the two groups in 5-year overall recurrence ( RR = 0. 89,95% CI:0. 74-1.07, P = 0. 200). Conclusions Laparoscopic surgery for colorectal carcinoma is a safe and effective therapy as open surgery in the short term or long term outcomes. It could be an acceptable alternative to open surgery for colorectal carcinoma.     

微创与开腹胰十二指肠切除术围手术期安全性的Meta分析

目的 系统评价微创与开腹胰十二指肠切除术围手术期的安全性.方法 以laparoscopic、laparoscopy、robotic、da Vinci、minimally invasive、pancreaticoduodenectomy、微创、腹腔镜、机器人、胰十二指肠切除术为关键词检索1989年至2013年中国期刊全文数据库（CNKI）、维普中文期刊数据库、PubMed、The Cochrane Library以及EMBASE等数据库中关于微创和开腹胰十二指肠切除术的随机对照研究和非随机对照研究.按照纳入与排除标准筛选文献,将纳入文献的患者分为微创手术组和开腹手术组,并将微创手术组进一步分为腹腔镜组和机器人组.提取数据后用RevMan 5.2软件进行Meta分析,比较微创与开腹行胰十二指肠切除术的疗效.计数资料采用优势比（OR）及95％可信区间（95％CI）表示,计量资料采用加权均数差（WMD）及95％ CI表示.采用I2对纳入的文献进行异质性分析.采用漏斗图分析可能潜在的发表偏倚,采用敏感性分析检测研究结果的稳定性.结果 10篇文献纳入本研究,共计690例患者,其中微创手术组235例（腹腔镜组128例,机器人组107例）,开腹手术组455例.Meta分析结果显示：微创手术组和开腹手术组围手术期总体并发症发生率、胰瘘发生率、胃排空障碍发生率、术后出血发生率、胆瘘发生率、再次手术率、病死率以及淋巴结清扫数目比较,差异无统计学意义（OR=0.75,1.01,0.98,1.50,0.94,0.56,1.06,WMD=2.29,95％ CI：0.40 ～ 1.41,0.67 ～ 1.53,0.55 ～ 1.77,0.76～2.94,0.37 ～2.38,0.26～ 1.20,0.48 ～2.32,-0.55～5.13,P＞0.05）.虽然微创手术组手术时间显著长于开腹手术组,但是微创手术组术中出血量显著减少,术后住院时间显著缩短,R0切除率显著提高（WMD=99.57,-355.70,-3.30,OR=0.49,95％ CI：36.99～162.15,-608.38 ～-103.01,-6.58～0.03,0.26～0.92,P＜0.05）.腹腔镜组手术时间显著长于开腹手术组（WMD =93.17,95％ C1：55.98 ～ 130.37,P＜0.05）.机器?     

腰椎后路椎体间融合术与后外侧融合术治疗腰椎退行性疾病的系统评价

[目的]系统评价腰椎后路椎体间融合术(posterior lumbar interbody fusion)对比后外侧融合术(posterolateral fusion)治疗腰椎退行性疾病的术后疗效.[方法]计算机检索PubMed、EMBASE、CNKI、CBM等数据库、学术会议资料和学位论文等.全面收集有关两种方法治疗腰椎退行性疾病的文献.制定文献纳入及排除标准,由2名研究者分别独立筛选文献,按照Cochrane Handbook 5.1进行严格的质量评估,并用Revman 5.2软件进行Meta分析.[结果]经过筛选,共有6篇研究符合纳入标准,包括487例患者被纳入分析.Meta分析结果显示,PLIF组的融合率＞ PLF组[OR=3.90,95％ CI (2.05,7.40),P＜0.001],但PLIF组术后1年ODI评分＜PLF组[WMD=-3.86,95％ CI(-7.59,-0.t3),P=0.04],差异具有统计学意义(P＜0.05);而两组在手术时间[WMD=15.85,95％CI(-16.25,47.96),P=0.33]、术中失血量[WMD=-90.57,95％ CI(-292.50,111.36),P=0.38]术后并发症[OR =0.99,95％CI (0.22,4.47),P=0.99]、二次手术率[OR =0.87,95％ CI (0.52,1.45),P=0.25]无统计学差异(P＞0.5).[结论] PLIF手术方式的骨融合率较高,但术后1年ODI评分低于PLF组,且两组在手术时间、术中失血量、术后并发症、二次手术率方面结果相似.     

机器人与传统腹腔镜远端胃癌根治术近期疗效对比的Meta分析

目的通过Meta分析的方法比较机器人远端胃癌根治术(远端胃大部切除术,RDG)与传统腹腔镜远端胃癌根治术(LDG)之间的近期疗效。方法检索包括EMBASE、Pubmed、Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普、万方数据库有关RDG与LDG优劣比较的研究,检索时间为建库至2020年10月。NOS评分系统评价文献质量。采用Review Manager 5.3软件进行统计分析。结果最终纳入符合标准的相关文献14篇共2 456例患者,其中RDG组852例(34.69%),LDG组1 604例(65.31%)。与LDG组相比,RDG组手术时间长(WMD=-22.59,95% CI:-25.55～-19.62,P0.001),术中失血量少(WMD=34.29,95% CI:20.71～47.87,P0.001),术后首次进食时间提前(WMD=0.33,95% CI:0.13～0.54,P=0.002),住院时间缩短(WMD=0.88,95% CI:0.05～1.71,P=0.04)。在术后首次排气时间、淋巴结清扫数目和总并发症发生率,以及腹部切口愈合不良、术后感染、术后腹腔出血、肠梗阻、肠漏等5种常见并发症方面,两组差异无统计学意义。结论 RDG可以减少术中失血量,缩短患者术后首次进食时间和住院时间,但是对于缩短手术时间、术后首次排气时间、淋巴结清扫数目和总并发症发生率方面无明显优势。     

前入路与常规入路右半肝巨大肝癌切除手术疗效的Meta分析

目的 系统比较前入路与常规入路肝癌切除术治疗大肝癌的效果.方法 计算机检索Medline、Embase、Cochrane,CNKl、万方、维普数据库中截止2013年4月的相关文献,收集比较前入路切除与常规切除治疗肝癌的随机临床对照试验研究.采用Meta分析软件RevMan 5.0对数据进行统计分析.结果 共纳入8个随机临床对照试验,患者总数615例(前入路肝切除304例,常规入路肝切除311例).结果显示,前入路肝切除术中失血量[加权均数差(WMD)=-680.2 ml;95％CI,-1023.97～-336.43;P=0.0001]、外科并发症(OR=0.59;95％ CI,0.38～0.93;P=0.02)、围手术期病死率(OR=0.37;95％ CI,0.21～0.67;P=0.0009)、术中输血率(OR=0.38;95％ CI,0.25～0.59;P＜0.01)、住院时间(WMD=-4.75 d;95％ CI,-7.82～-1.67;P=0.002)、肿瘤破裂发生率(OR=0.33;95％ CI,0.11～0.97;P=0.04)明显优于常规入路切除术.两种入路手术时间无明显统计学意义.结论 前入路肝脏切除术与常规入路比较,具有术中出血量少,输血率、外科并发症发生率、肿瘤破裂发生率、围手术期病死率较低,住院时间较短等优点.两者手术时间比较无明显差别.     

腹主动脉瘤破裂腔内治疗的荟萃分析

目的 系统评价血管腔内修复术(vascular edovascular repair,EVAR)治疗腹主动脉瘤破裂(ruptured abdominal aortic aneurysms,RAAA)的有效性与安全性.方法 计算机检索PubMed、MEDLINE、EMBASE、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库及中国期刊全文数据库等数据库,并辅以手工检索近年发表的中文期刊.对纳入文献采用RevMan 5.0.18软件进行Meta分析.结果 纳入9篇文献.1篇随机对照试验(RCT),8篇队列研究共2402例患者,Meta分析结果显示:与开放手术比较,血管腔内修复术可明显降低术后30 d死亡率[OR =0.47,95％ CI(0.39,0.57),P＜0.01]和并发症发生率OR=0.47,95％ CI(0.39,0.57),P＜0.01.血管腔内修复术与开放手术相比,在术后早期再手术率[ OR=0.86,95％ CI(0.55,1.33),P=0.5]及中期死亡率[OR=1.24,95％ CI(0.46,3.37),P＜0.67]方面差异无统计学意义(P＞0.05).结论 对于合适的腹主动脉瘤破裂的患者,腔内治疗是可行的,并且逐渐显现出相对传统开腹手术更大的优势,短期疗效较好,术后并发症相对较少.     

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。     

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??Comparison of the short-term outcome of splenic hilar lymph node dissection in laparoscopic and open total gastrectomy D2 radical gastrectomy ??A Meta analysis HU Lin??LI Chang-rong??LI Wei-feng??et al. Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006??China
Corresponding author: LI Hong-lang, E-mail??lihonglang6802@163.com
Abstract Objective To evaluate the safety and feasibility of laparoscopic spleen-preserving splenic hilar lymphadenectomy in radical gastrectomy. Methods The literatures before October, 2014 were searched extensively to retrieve the comparative studies of laparoscopic and open spleen-preserving splenic hilar lymphadenectomy in radical gastrectomy with a relevance of study goal??The inclusion and exclusion criteria were formulated??After a quality evaluation, the data were extracted??The Cochrane Collaboration RevMan 5.2 version software was used for Meta-analysis??Results A total of six studies met the inclusion criteria for Meta-analysis??Compared with the open surgery, laparoscopic spleen-preserving splenic hilar lymphadenectomy experienced less blood loss??WMD=135.62??95%CI 61.04-210.20??P<0.05), earlier time to flatus??WMD=0.73??95%CI 0.27-1.20??P<0.05??, shorter resume soft diet time??WMD=1.05??95%CI 0.88-1.22??P<0.05??, shorter hospital stay??WMD=4.16, 95%CI 2.45-5.88??P<0.05), more dissected lymph nodes??WND= -2.11, 95%CI -3.31--0.90??P<0.05), longer operative time??WMD=-34.62, 95%CI -54.71--12.53??P=0.002). Conclusion Compared with open operation, laparoscopic total gastrectomy concurrent splenic hilar lymphnode dissection has the advantages of less blood loss and quick recovery.     

腹腔镜与开放全胃切除D2胃癌根治术行脾门淋巴结清扫疗效对照Meta分析

目的 评价开放与腹腔镜全胃切除D2胃癌根治术行脾门淋巴结清扫的优劣。方法 检索2000年1月至2014年10月公开发表的对比腹腔镜脾门淋巴结清扫和开放脾门淋巴结清扫在全胃癌根治术中应用的文献。按纳入标准筛选后进行质量评分,提取临床效应指标,采用RevMan5.2软件对所纳入的数据进行Meta分析。
结果 共有6项研究纳入分析。Meta分析结果显示：与开放组相比,腹腔镜脾门淋巴结清扫手术失血量少［加权均数差（weighted mean difference,WMD）=135.62,95%CI 61.04~ 210.20,P<0.05］、术后排气时间早（WMD=0.73,95%CI 0.27~ 1.20,P<0.05）、恢复饮食快（WMD=1.05,95%CI 0.88~ 1.22,P<0.05）、住院时间短（WMD=4.16,95%CI 2.45~ 5.88,P<0.05）、淋巴结清扫数量多（WMD= -2.11,95%CI -3.31~-0.90,P<0.05）、但手术时间较长（WMD= -34.62,95%CI -54.71~ -12.53,P=0.002） 结论 与开放手术相比,腹腔镜全胃切除并行脾门淋巴结清扫具有术中出血少、恢复快等优势。     

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??Laparoscopic and conventional open gastrectomy in the treatment of early gastric cancer: A meta-analysis of effectiveness and safety XU Tian-en, FAN Wen-juan, JIANG Lei, et al. Department of Oncology, First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China
Corresponding author: GUAN Quan-lin, E-mail??ldyyzlwk2012@163.com
Abstract Objective To compare the effectiveness and safety of laparoscopic and conventional open gastrectomy in the treatment of early gastric cancer. Methods Randomized controlled trials (RCTs) of LADG and CODG published between 2002 and 2012 in PubMed, Cochrane library, Embase, Chinese Biomedical Literature Database (CBM), CNKI and VIP were searched. All the data were analyzed by 2 reviewers independently using RevMan5.1software. Results Seven RCTs were included totally including 699 patients with gastric cancer. The result of meta-analysis showed that: There is significant difference in the number of lymph nodes dissected [WMD(weighted mean differences)=3.87 95%CI??-5.87, -1.87?? P=0.0002], intraoperative blood loss [SMD(standardized mean differences)=0.78 95%CI??-0.94, -0.63??P<0.00001], operation time [WMD??62.67 95%CI??57.35, 67.99??P<0.00001], postoperative total complication incidence [OR=0.42 95%CI??0.27, 0.67??P=0.0002] and pulmonary complication incidence [OR=0.42 95%CI??0.17, 1.00??P=0.05] between conventional open gastrectomy group and laparoscopic group. No statistical significance difference was found in postoperative survival rate in 5 years [54.8%, 55.7%], the perioperative mortality [OR=0.96 95%CI??0.24, 3.94?? P=0.96] and postoperative recurrence rate [OR=1.27 95%CI??0.48, 3.34??P=0.62]. Conclusion The current clinical evidence shows that compared with conventional open gastrectomy, laparoscopic gastrectomy has less postoperative total complications with the similar short-term outcome but laparoscopic gastrectomy is a procedure with high surgical technique and long operation time.     

Aneurysm-related death: primary endpoint analysis for comparison of open and endovascular repair

PURPOSE: The purpose of this study was to utilize an objective endpoint analysis of aneurysm treatment, which is based on the primary objective of aneurysm repair, and to apply it to a consecutive series of patients undergoing open and endovascular repair. METHOD: Aneurysm-related death was defined as any death that occurred within 30 days of primary aneurysm treatment (open or endovascular), within 30 days of a secondary aneurysm or graft-related treatment, or any death related to the aneurysm or graft at any time following treatment. We reviewed 417 consecutive patients undergoing elective infrarenal aortic aneurysm repair: 243 patients with open repair and 174 patients with endovascular repair. RESULTS: There was no difference between the groups (open vs endovascular) with regard to mean age +/- standard deviation (73 +/- 8 years vs 74 +/- 8 years) or aneurysm size (64 +/- 2 mm vs 58 +/- 10 mm) (P = not significant [NS]). The 30-day mortality for the primary procedure after open repair was 3.7% (9/243) and after endovascular repair was 0.6% (1/174, P <.05). The 30-day mortality for secondary procedures after open repair was 14% (6/41) compared to 0% after endovascular repair (P <.05). The aneurysm-related death rate was 4.1% (10/243) after open surgery and 0.6% (1/174) after endovascular repair (P <.05). Mean follow-up was 5 months longer following open repair (P <.05). Secondary procedures were performed in 41 patients following open surgery and 27 patients following endovascular repair (P = NS). Secondary procedures following open repair were performed for anastomotic aneurysms (n = 18), graft infection (n = 6), aortoenteric fistula (n = 5), anastomotic hemorrhage (n = 4), lower extremity amputation (n = 4), graft thrombosis (n = 3), and distal revascularization (n = 1). Secondary procedures following endovascular repair consisted of proximal extender cuffs (n = 11), distal extender cuffs (n = 11), limb thrombosis (n = 3), and surgical conversion (n = 2). The magnitude of secondary procedures following open repair was greater with longer operative time 292 +/- 89 minutes vs 129 +/- 33 minutes (P <.0001), longer length of stay 13 +/- 10 days vs 2 +/- 2 days (P <.0001) and greater blood loss 3382 +/- 4278 mL vs 851 +/- 114 mL (P <.0001). CONCLUSIONS: The aneurysm-related death rate combines early and late deaths and should be used as the primary outcome measure to objectively compare the results of open and endovascular repair in the treatment of infrarenal abdominal aortic aneurysms. In our experience, endovascular aneurysm repair reduced the overall aneurysm-related death rate when compared to open repair. Secondary procedures are required after both open and endovascular repair. However, the magnitude, morbidity, and mortality of secondary procedures are reduced significantly with endovascular repair.     

The rupture rate of large abdominal aortic aneurysms: is this modified by anatomical suitability for endovascular repair?

BACKGROUND: There are no precise estimates of the rate of rupture of large abdominal aortic aneurysms (AAA). There is recent suspicion that anatomic suitability for endovascular repair may be associated with a decreased risk of AAA rupture. METHODS: Systematic literature review of rupture rates of AAA with initial diameter > or =5 cm in patients not considered for open repair, with stratification by size (<6.0 cm and 6.0+ cm), and gender, combined using random-effects meta-analysis. Proportional hazards regression to analyze factors (including gender, diabetes, initial AAA diameter, aneurysm neck, and sac lengths) associated with rupture in patients anatomically suitable for endovascular repair (EVAR 2 trial). RESULTS: Previous studies (2 prospective, 2 retrospective, and 1 mixed) were identified for meta-analysis and patients with elective repair excluded. The pooled rupture rates was 18.2 [95% confidence interval (CI) 13.7-24.1] per 100 person-years. There was a 2.5-fold increase in rupture rates for patients with AAA of 6.0+ cm versus <6.0 cm, rupture rates = 2.54 (95% CI 1.69-3.85). The pooled rupture rates was nonsignificantly higher in women than men, rupture rates = 1.21 (95% CI 0.77-1.90). For EVAR 2 patients with 6+ cm aneurysms the rupture rates was 17.4 [95% CI 12.9-23.4] per 100 person-years significantly lower than the pooled rate from the meta-analysis, rupture rates = 27.0 [95% CI 21.1-34.7] per 100 person-years, P = 0.026. Patients with shorter neck lengths appeared to have a higher rupture rates than those with longer necks, but this was of borderline significance P = 0.10. CONCLUSIONS: Rupture rates of large AAAs reported in different studies are highly variable. There is emerging evidence that patients anatomically suitable for endovascular repair have lower rupture rates.     

肝脾联合切除治疗肝癌合并肝硬化脾功能亢进的Meta分析

目的 系统评价肝脾联合切除治疗肝癌伴肝硬化脾功能亢进的安全性和疗效.方法 计算机检索Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、万方数据库中的相关文献,所有检索均截止至2009年8月.由2名评价员筛选和提取资料,并用Minors量表进行质量评估.对符合纳入标准的研究采用RevMan5软件进行统计分析.结果 共纳入5个非随机对照试验,患者总数476例(肝脾联合切除组232例,单纯肝癌切除组244例).结果 显示肝脾联合切除组(HS组)与单纯肝癌切除组(H组)手术病死率和术后并发症发生率比较无统计学差异,OR值(95%CI)分别为0.57(95%CI 0.12～2.66,P=0.47)和0.93(95%CI 0.59～1.46,P=0.75).与H组相比,HS组术后CD4+T细胞比例、CD4+T细胞/CD8+T细胞比值、白细胞和血小板计数均明显上升,其WMD值(95%CI)分别为7.90(7.01～8.79,P＜0.01)、0.75(0.70～0.80,P＜0.01)、5.47(5.13～5.82,P＜0.01)、174.89(116.61～233.18,P＜0.01).术后CD8+T细胞下降,其WMD值(95%CI为-7.66(-8.53～-6.79,P＜0.01).两组术后5年生存率的OR值(95%CI)为1.37(0.86～2.18,P=0.18).结论 根据已有文献,肝脾联合切除术治疗肝癌伴肝硬化脾功能亢进未增加手术病死率及术后并发症发生率,且可显著提高患者术后白细胞和血小板计数,改善机体免疫功能,但目前证据未表明能提高术后5年生存率.

Abstract：

Objective To systematically evaluate the efficacy and safety of combined hepatectomy and splenectomy in hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism.Methods Medline (1966-August 2009), Embase (1974-August 2009), Cochrane Library, CBMdisc (1978-August 2009), and Wanfang Database were searched without language limitation. All relevant studies were screened and the data were extracted by two independent reviewers, and the methodological qualities of the included studies were evaluated by the Minors scale. The data were analyzed with the RevMan5 software. Results Five non-randomized comparative studies (NRCs) involving 476 patients (232 in HS group, 244 in control group) were enrolled into the analysis. There was no significant difference in the operative mortalities (OR=0. 57, 95%CI 0. 12-2. 66, P=0. 47) and postoperative morbidities (OR= 0. 93, 95 % CI 0.59- 1.46, P = 0.75) between the two groups. Compared with hepatectomy only, CD4+ T cell (WMD=7.90, 95%CI 7.01-8.79, P＜0.01), CD4+ T cell/CD8+ T cell ratio (WMD=0. 75, 95%CI 0. 70-0.80, P＜0.01), white blood cell count (WMD=5.47, 95%CI 5.13-5.82, P＜0.01) and platelet count (WMD=174.89, 95%CI 116.61-233.18,P＜0.01) were significantly higher, but CD8+ T cell (WMD = - 7.66, 95%CI - 8. 53～ - 6. 79,P＜0. 01) was lower compared with combined hepatectomy and splenectomy. There was no significant difference in the 5-year survival rates (OR= 1.37, 95%CI 0.86-2.18, P=0. 18). Conclusion Combined hepatectomy and splenectomy did not increase the operative mortalities and postoperative morbidities in hepatocellular carcinoma complicated with hepatic cirrhosis and hypersplenism. The white blood cell and platelet counts markedly increased after surgery. There was no evidence to show any improvement in the 5-year survival.     

腹腔镜结直肠癌手术患者围手术期应用快速康复外科的系统评价

目的系统评价腹腔镜结直肠癌手术患者应用快速康复外科（FTs）的安全性和有效性。方法计算机检索2000年1月至2012年3月CNKI、万方、Pubmed、EMBACE、CochraneLibrary数据库关于腹腔镜结直肠癌根治术围手术期应用FTS的随机对照试验（RCT）或临床对照试验（CCT）。采用RevMan5．1软件进行Meta分析。结果6项RCT和7项CCT研究纳入研究．共1795例患者,其中FTS组955例,对照组840例。与对照组相比．FTS组患者术后排气更快（WMD=-1．37,95％CI：-1．55～-1．19,P〈0．05）,术后进食更早（WMD=-2．62,95％CI：-2．69～-2．55,P〈0．05）,术后住院时间缩短（WMD=-1．63,95％CI：-1．92～-1．34,P〈0．05）,术后并发症发生率降低（OR=0．52,95％CI：0．41～0．67,P〈O．05）;但两组术后再入院率的差异无统计学意义（P〉0．05）。结论FTS理念应用于腹腔镜结直肠癌根治术,可有效促进术后肠功能恢复,减少并发症的发生,缩短住院时间。     

腔内修复术与开放手术治疗急性Stanford B型主动脉夹层疗效评价

目的系统评价腔内修复术（覆膜支架置入术）与开放手术治疗急性Stanford B型主动脉夹层的有效性与安全性。方法计算机检索1991年1月至2013年1月期间收录在CNKI、万方、维普、Cochrane图书馆临床对照试验中心注册库、OVID、Pubmed Medline、EBSCO、EMBASE、Springer Link、Science Direct等数据库中关于主动脉腔内修复术和开放手术治疗急性StanfordB型主动脉夹层的临床对照试验文献,用RevMan5.1软件对符合标准的临床试验数据进行分析。结果8个临床试验共纳入5618例急性B型主动脉夹层患者,腔内修复术组与开放手术组治疗后30d死亡率差异有统计学意义,腔内修复组明显优于开放手术组[OR=0.55,95％CI（0.46～0.65）,P〈0.00001]。另外,中风（OR=0.57,95％C1（0.39～0184）,P=0.005]、呼吸衰竭[OR=0.64,95％CI（0.53～0.78）,P〈0.00001]和心脏并发症[OR=O.49,95％CI（0.38～0.64）,P〈0.00001]的发生率差异均有统计学意义,腔内修复组优于开放手术组;截瘫[OR=I.30,95％C1（0.82～2.05）,P=0.26]和急性肾功能衰竭[OR=0.86,95％CI（0.41～1.80）,P=0.69]的发生率差异无统计学意义。结论腔内修复术可以作为治疗急性StanfordB型主动脉夹层的首选治疗方法。     

腹腔镜与开腹大范围肝切除治疗肝脏肿瘤的荟萃分析

目的:采用荟萃分析比较腹腔镜与开腹大范围肝切除治疗肝脏肿瘤的近期疗效及安全性。方法:大范围肝切除术是≥3个肝段的肝切除手术。计算机检索至2014年6月的Pub Med、EMbase、Cochrane、CBM、CNKI、万方、维普数据库相关文献,收集并比较两种方式治疗肝脏肿瘤的临床对照研究。采用Rev Man5.2软件对数据行荟萃分析。结果:未获得随机对照试验,纳入7项临床同期对照试验,共863例(腹腔镜组275例,开腹组588例)。荟萃分析结果显示:腹腔镜大范围肝切除术中出血量[加权均数差(weight mean difference,WMD)为-158.38 m L,95%CI:-233.81~-82.96,P