快速康复外科应用于胃癌切除术的安全性和可行性的Meta分析

Safety and feasibility of fast track surgery in operations for gastric cancer： a meta analysis

目的系统评价快速康复外科（FPS）应用于胃癌切除术的安全性和可行性。方法以gastriccancer、gastriccarcinoma、FTS、fasttracksurgery、enhanced recovery after surgery、ERAS、胃癌、快速康复外科等为关键词检索CochraneLibrary、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库。检索时间截至2011年4月。纳入Frs应用于胃癌切除的随机对照试验，由2名研究员分别独立提取数据和进行文献质量评价，并用RevMan5．1．2软件进行Meta分析。结果共纳入14篇随机对照试验，共计病例1270例。Meta分析结果显示：FTS能显著缩短胃癌患者术后首次肛门排气时间（MD=-6．15，95％可信区间：-8．22- -4．07，P〈0．05）和住院时间（MD=-2．68，95％可信区间：-3．26- -2．10，P〈0．05），降低住院费用（MD=-0．39，95％可信区间：-0．55- -0．22，P〈0．05），减轻胃癌患者术后应激反应，相对增强机体免疫力。结论与传统胃癌切除手术比较，FTS能够加快胃癌患者术后康复，并未增加不良反应，值得临床推广和应用。

Objective To estimate the safety and feasibility of fast track surgery （FTS） in operations forgastric cancer. Methods The Cochrane library, PubMed, EMBASE, Chinese biomedical literature database, China journal full text database, Chinese scientific journals full text database were searched with the key words of ＂gastric cancer＂, ＂gastric carcinoma＂, ＂ FTS＂, ＂fast track surgery＂, ＂ enhanced recovery after surgery＂, ＂ERAS＂, ＂胃癌＂, and ＂快速康复外科＂. The search was finished in April, 2011. Randomized controlled trials of FTS for patients with gastric cancer were included. Two reviewers evaluated the quality of the included studies and extracted the data independently. Meta analysis was performed by RevMan 5.1.2 software. Results Fourteen randomized controlled trials involving 1270 patients were included. The results of meta analysis showed that FTS could significantly shorten the first exhaust time （ MD = - 6. 15, 95 % confidence interval ： - 8.22- - 4. 07, P 〈0.05） and hospital stay （MD = - 2. 68, 95% confidence interval： - 3.26- - 2. 10, P 〈 0.05 ）, and reduced the hospital fees （MD =-0. 39, 95% confidence interval： -0. 55- -0. 22, P 〈0.05）. FTS could lighten the post- operative stress and relatively enhance the immunity. Conclusion Compared with conventional methods, FTS could speed up the rehabilitation for patients with gastric cancer postoperatively without increasin~ the adverse reactions.