腹腔镜结直肠癌手术患者围手术期应用快速康复外科的系统评价

Systemic review of fast-track surgery in patients undergoing laparoscopic colorectal resection

目的系统评价腹腔镜结直肠癌手术患者应用快速康复外科（FTs）的安全性和有效性。方法计算机检索2000年1月至2012年3月CNKI、万方、Pubmed、EMBACE、CochraneLibrary数据库关于腹腔镜结直肠癌根治术围手术期应用FTS的随机对照试验（RCT）或临床对照试验（CCT）。采用RevMan5．1软件进行Meta分析。结果6项RCT和7项CCT研究纳入研究．共1795例患者，其中FTS组955例，对照组840例。与对照组相比．FTS组患者术后排气更快（WMD=-1．37，95％CI：-1．55～-1．19，P〈0．05），术后进食更早（WMD=-2．62，95％CI：-2．69～-2．55，P〈0．05），术后住院时间缩短（WMD=-1．63，95％CI：-1．92～-1．34，P〈0．05），术后并发症发生率降低（OR=0．52，95％CI：0．41～0．67，P〈O．05）；但两组术后再入院率的差异无统计学意义（P〉0．05）。结论FTS理念应用于腹腔镜结直肠癌根治术，可有效促进术后肠功能恢复，减少并发症的发生，缩短住院时间。

Objective To evaluate the efficacy and safety of fast track surgery（Frs） in patients undergoing laparoseopic colorectal resection. Method Randomized controlled trials （RCT） or clinical controlled trials（CCT） on fast-track surgery in patients undergoing laparoscopic colorectal resection were obtained from databases including CNKI, Wanfang, PubMed, EMBACE, and Cochrane Library between January 2000 and March 2012. Meta-analysis was performed with RevMan 5.1. Result There were 6 RCTs and 7 CCTs including 1795 patients. There were 955 patients in the FTS group and 840 in the control group. The time to passage of flatus was shorter （WMD=-l.37, 95%CI：-1.55～-1.19, P〈 0.05）, time to resumption of diet/drink was shorter （WMD=-2.62, 95%CI：-2.69～-2.55, P〈0.05）, length of postoperative hospital stay was decreased （WMD=-l.63, 95%CI：-1.92～-1.34, P〈0.05） and the incidence of postoperative complications were less （0R=0.52, 95%CI：0.41～0.67, P〈O.05） in the FTS group. However, there were no differences in readmission （P〉0.05）. Conclusion Fast-track surgery in patients undergoing laparoscopic colorectal resection can promote bowel function recovery, decrease the incidence of postoperative complications and length of hospital stay.