【摘要】 目的 評(píng)價(jià)在鼻煙壺及腕部行動(dòng)靜脈造瘺術(shù)的療效?！》椒ā?007年6月-2009年6月收治的156例腎功能衰竭患者隨機(jī)分成兩組，分別在鼻煙壺及腕部行動(dòng)靜脈造瘺術(shù)，術(shù)后經(jīng)彩色超聲隨訪其吻合口通暢情況，臨床觀察瘺管使用時(shí)間及其并發(fā)癥?！〗Y(jié)果 術(shù)后隨訪2年，鼻煙壺處行動(dòng)靜脈造瘺術(shù)的患者，瘺管術(shù)后1年初級(jí)通暢率及累積次級(jí)通暢率分別為76.9%、92.1%；術(shù)后2年初級(jí)通暢率及累積次級(jí)通暢率分別為57.9%、78.9%。而腕部組瘺管1年初級(jí)通暢率及累積次級(jí)通暢率分別為64.1%、81.3%；術(shù)后2年初級(jí)通暢率及累積次級(jí)通暢率分別為56.0%、76.0%。兩組在術(shù)后1年初級(jí)通暢率及累積次級(jí)通暢率差異有統(tǒng)計(jì)學(xué)意義（Plt;0.01），術(shù)后2年初級(jí)通暢率及累積次級(jí)通暢率差異無統(tǒng)計(jì)學(xué)意義（Pgt;0.05）?！〗Y(jié)論 鼻煙壺處行動(dòng)靜脈造瘺術(shù)的瘺管在短期內(nèi)通暢率較腕部高，長(zhǎng)期并無顯著性差異?！続bstract】 Objective To evaluate the effect of artificial arteriovenous fistula between tabatiere anatomique and wrist. Methods From June 2007 to June 2009, 156 cases of renal failure were randomly divided into two groups, and underwent artificial arteriovenous fistula on tabatiere anatomique or wrist, respectively. The patency of the anastomotic stoma was observed via B ultrasonography. Results The patients were followed up for two years postoperative. After the operation, the primary patency was 76.9% at the first year and 57.9% at the second year in tabatiere anatomique group; cumulative secondary patency was 92.1% at the first year and 78.9% at the second in tabatiere anatomique group; primary patency was 64.1% at the first year and 56.0% at the second in wrist group; cumulative secondary patency was 81.3% at the first year and 76.0% at the second year in wrist group. The primary patency and cumulative secondary patency were significantly different between tabatiere anatomique group and wrist group at the first year postoperatively (Plt;0.01) and not significant at the second year postoperatively (Pgt;0.05). Conclusion Prophase patency of tabatiere anatomique is higher than that of wrist. There was no significant difference between them in a long term.
目的 系統(tǒng)評(píng)價(jià)胰十二指腸切除術(shù)后早期應(yīng)用腸內(nèi)營(yíng)養(yǎng)與完全胃腸外營(yíng)養(yǎng)的有效性及安全性。方法 計(jì)算機(jī)檢索MEDLINE、EMbase、Cochrane圖書館、CBM、VIP、CNKI數(shù)據(jù)庫，納入胰十二指腸切除術(shù)后早期應(yīng)用腸內(nèi)營(yíng)養(yǎng)的隨機(jī)對(duì)照試驗(yàn)。檢索時(shí)間為2000～2010.3，按納入排除標(biāo)準(zhǔn)由2位研究者獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取和方法學(xué)質(zhì)量評(píng)價(jià)后，采用RevMan 5.0軟件進(jìn)行Meta分析。結(jié)果 共納入4個(gè)RCT，涉及行胰十二指腸切除術(shù)患者322例。Meta分析結(jié)果顯示，胰十二指腸切除術(shù)后早期應(yīng)用腸內(nèi)營(yíng)養(yǎng)（試驗(yàn)組）與完全胃腸外營(yíng)養(yǎng)（對(duì)照組）相比，術(shù)后平均住院時(shí)間［MD= –2.34，95%CI（–3.91，–0.77），Plt;0.05］、總并發(fā)癥發(fā)生率［RR=0.75，95%CI（0.57，0.99），P=0.04］、腸蠕動(dòng)恢復(fù)時(shí)間［MD= –29.87，95%CI（–33.01，–26.73），Plt;0.05］、住院營(yíng)養(yǎng)費(fèi)用［MD= –30.51，95%CI（–35.78，–25.24），Plt;0.05］有統(tǒng)計(jì)學(xué)差異，試驗(yàn)組不同程度優(yōu)于對(duì)照組；而在病死率［RR=0.23，95%CI（0.03，2.03），P=0.19］、胰漏［RR=0.78，95%CI（0.45，1.35），P=0.38］、感染并發(fā)癥［RR=0.71，95%CI（0.43，1.18），P=0.19］、非感染并發(fā)癥［RR=0.78，95%CI（0.51，1.20），P=0.26］、術(shù)后血漿白蛋白［MD= –0.79，95%CI（–2.84，1.27），P=0.45］等指標(biāo)上兩組差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 胰十二指腸切除術(shù)后早期應(yīng)用腸內(nèi)營(yíng)養(yǎng)與完全胃腸外營(yíng)養(yǎng)相比，具有較為明顯的優(yōu)勢(shì)，但由于納入試驗(yàn)的方法學(xué)質(zhì)量普遍較低，期待更多設(shè)計(jì)合理的大樣本隨機(jī)雙盲對(duì)照試驗(yàn)提供高質(zhì)量的證據(jù)。