【摘要】 目的 評價在鼻煙壺及腕部行動靜脈造瘺術的療效?！》椒ā?007年6月-2009年6月收治的156例腎功能衰竭患者隨機分成兩組，分別在鼻煙壺及腕部行動靜脈造瘺術，術后經彩色超聲隨訪其吻合口通暢情況，臨床觀察瘺管使用時間及其并發(fā)癥?！〗Y果 術后隨訪2年，鼻煙壺處行動靜脈造瘺術的患者，瘺管術后1年初級通暢率及累積次級通暢率分別為76.9%、92.1%；術后2年初級通暢率及累積次級通暢率分別為57.9%、78.9%。而腕部組瘺管1年初級通暢率及累積次級通暢率分別為64.1%、81.3%；術后2年初級通暢率及累積次級通暢率分別為56.0%、76.0%。兩組在術后1年初級通暢率及累積次級通暢率差異有統(tǒng)計學意義（Plt;0.01），術后2年初級通暢率及累積次級通暢率差異無統(tǒng)計學意義（Pgt;0.05）?！〗Y論 鼻煙壺處行動靜脈造瘺術的瘺管在短期內通暢率較腕部高，長期并無顯著性差異?！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)評價胰十二指腸切除術后早期應用腸內營養(yǎng)與完全胃腸外營養(yǎng)的有效性及安全性。方法 計算機檢索MEDLINE、EMbase、Cochrane圖書館、CBM、VIP、CNKI數據庫，納入胰十二指腸切除術后早期應用腸內營養(yǎng)的隨機對照試驗。檢索時間為2000～2010.3，按納入排除標準由2位研究者獨立進行文獻篩選、資料提取和方法學質量評價后，采用RevMan 5.0軟件進行Meta分析。結果 共納入4個RCT，涉及行胰十二指腸切除術患者322例。Meta分析結果顯示，胰十二指腸切除術后早期應用腸內營養(yǎng)（試驗組）與完全胃腸外營養(yǎng)（對照組）相比，術后平均住院時間［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］、腸蠕動恢復時間［MD= –29.87，95%CI（–33.01，–26.73），Plt;0.05］、住院營養(yǎng)費用［MD= –30.51，95%CI（–35.78，–25.24），Plt;0.05］有統(tǒng)計學差異，試驗組不同程度優(yōu)于對照組；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］、術后血漿白蛋白［MD= –0.79，95%CI（–2.84，1.27），P=0.45］等指標上兩組差異無統(tǒng)計學意義。結論 胰十二指腸切除術后早期應用腸內營養(yǎng)與完全胃腸外營養(yǎng)相比，具有較為明顯的優(yōu)勢，但由于納入試驗的方法學質量普遍較低，期待更多設計合理的大樣本隨機雙盲對照試驗提供高質量的證據。