循证医学作业
病史:患者男性,45岁,因“反复便血2月”入院。近两月前,患者无明显诱因下出现反复出现便血,呈暗红色,量不多,无发烧、无恶心、呕吐,无腹痛腹胀,无肛周疼痛,大便次数增多,一天2-3次,大便成形,无大便变细。
体魄检查:体温:37.2℃;脉搏:85次/分;呼吸:20次/分;血压:128/72mmHg。一般情形尚好,自动体位。皮肤巩膜无明显黄染,心肺(—)。腹部平坦,腹无压痛、反跳痛(-),肝脾肋下未触及,未及腹部肿块。双侧下肢无水肿,神经系统体征(—)。肛门指检:未及直肠肿块,指套染血。
入院后检查:B超:肝、胆、脾、胰、肾未见明显异样。电子肠镜提示:距肛约10厘米一直肠肿块,占肠腔1/3圈,取活检二处,余结肠未见明显异样。活检病理:直肠中分化腺癌。
诊断:直肠癌。 收入我院进行手术医治
一. P I C O 患者直肠癌诊断明确,医治方式传统术式为:直肠癌根治术(Dixon)。
PICO与提出临床问题
直肠癌 腹腔镜手术 开腹手术 根治性如何 但随着腹腔镜技术的进展,和其给病人带来创伤少,恢复快的特点愈来愈引发重视。病人家眷提出:像患者的病情是不是适合腹腔镜手术,与开腹手术相较其根治性如何,是不是安全?
二.证据检索
1. 证据来源:
PUBMED和Cochrane图书馆
2. 检索词和检索策略: (1) 检索词:
直肠癌[rectal cancer OR rectal carcinoma]、开放手术[open abdominoperineal resection OR open approach] 腹腔镜 [laparoscopic ] (2) 检索词组合:
[rectal cancer OR rectal carcinoma] AND [open abdominoperineal resection OR open approach] AND [laparoscopic ]
(3) 检索结果:
A. PUBMED--Clinical Queries--Find Systematic Reviews: 共6篇,其中5篇Review,1篇META分析。
1: Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003432. Review. PMID: [PubMed - indexed for MEDLINE]
2: Kuhry E, Saetnan E, Graeslie H, Gaupset R. [Laparoscopic surgery for colorectal cancer]
Tidsskr Nor Laegeforen. 2007 Nov 15;127(22):2946-9. Review. Norwegian. PMID: [PubMed - indexed for MEDLINE]
3: Breukink S, Pierie J, Wiggers T.
Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005200. Review. PMID: [PubMed - indexed for MEDLINE]
4: Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG.
Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006 Mar;13(3):413-24. Epub 2006 Feb 1. PMID: [PubMed - indexed for MEDLINE]
5: Meyer C, Kanor MA, Rohr S, Reche F.
[Critical analysis of the laparoscopic approach in colorectal surgery based on the personal experience of 613 interventions]
Bull Acad Natl Med. 2003;187(3):507-19. Review. French. PMID: [PubMed - indexed for MEDLINE]
6: Bachoo P, Brazzelli M, Grant A.
Surgery for complete rectal prolapse in adults.
循证医学作业(3)
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