中国循证医学杂志

中国循证医学杂志

快速康复外科在胰十二指肠切除术中应用的有效性和安全性的 Meta 分析

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目的系统评价快速康复外科(ERAS)在胰十二指肠切除术中应用的有效性和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI 和 VIP 数据库,搜集胰十二指肠切除术患者围手术期采用 ERAS 与传统康复管理比较的临床对照研究,检索时限均从建库至 2017 年 3 月 31 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 12 个非随机非同期对照研究,包括 2 588 例患者。Meta 分析结果显示:对比传统术后康复,ERAS 能缩短胰十二指肠术后患者的住院时间[MD=–5.44,95%CI(–7.73,–3.15),P<0.000 01]、术后首次肛门排气时间[MD=–1.40,95%CI(–2.60,–0.20),P=0.02]、减少术后总并发症发生率[OR=0.61,95%CI(0.52,0.72),P<0.000 01]、胰瘘发生率[OR=0.81,95%CI(0.66,0.99),P=0.04]和胃排空障碍发生率[OR=0.49,95%CI(0.38,0.63),P<0.000 01]。但两组在术后胆瘘、腹腔感染、伤口感染和肺部感染发生率方面,差异均无统计学意义。结论ERAS 应用于胰十二指肠切除术围手术期有效且安全。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

ObjectiveTo systematically review the efficacy and safety of enhanced recovery after pancreaticoduodenectomy surgery (ERAS).MethodsPubMed, EMbase, The Cochrane library, CBM, CNKI and VIP databases were electronically searched to collect clinical controlled trials of comparing ERAS and the traditional rehabilitation management in patients who received pancreaticoduodenectomy from inception to March 31st, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.2 software.ResultsA total of 12 non-randomized historical controlled trials involving 2 588 patients were included. The results of meta-analysis showed that ERAS shortened postoperative hospital stay (MD=–5.44, 95%CI –7.73 to –3.15, P<0.000 01) and the time to the first passage of flatus (MD=–1.40, 95%CI –2.60 to –0.20,P=0.02), reduced the rate of postoperative complication (OR=0.61, 95%CI 0.52 to 0.72, P<0.000 01), pancreatic fistula (OR=0.81, 95%CI 0.66 to 0.99,P=0.04) and delayed gastric emptying (OR=0.49, 95%CI 0.38 to 0.63, P<0.000 01). However, there was no significant difference in incidences of biliary fistula, abdominal cavity infection, wound infection and postoperative pulmonary infection between two groups.ConclusionsThe application of ERAS in pancreaticoduodenectomy is effective and does not increase postoperative complication. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关键词: 胰十二指肠切除术; 快速康复外科; Meta 分析; 系统评价

Key words: Pancreaticoduodenectomy; Enhanced recovery after surgery; Meta-analysis; Systematic review

引用本文: 董春禄, 樊文娟. 快速康复外科在胰十二指肠切除术中应用的有效性和安全性的 Meta 分析. 中国循证医学杂志, 2018, 18(5): 463-469. doi: 10.7507/1672-2531.201705045 复制

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