加速康复外科对胃肠道恶性肿瘤术后病人临床结局的影响

The impact of fast track surgery strategy on gastroenterological malignant tumor patients who undergo selective resection operation

目的:系统评价加速康复外科(FTS)对接受手术治疗的胃肠道恶性肿瘤病人临床预后和治疗费用的影响。方法:检索中国生物医学文献数据库(CBM)、中国知网(CNKI)和维普数据库(VIP),鉴定随机对照研究(RCT)。纳入标准:①采用随机对照的临床研究,设立平行对照,正确描述随机化方法;②因胃肠道恶性肿瘤接受根治性切除手术;③是否接受围术期FTS干预,是两组唯一差异;④报告至少一项临床结局指标,包括术后并发症、住院时间、肠道功能恢复时间(肛门排气排便)和费用。研究的方法学质量按Cochrane评价员手册及改良Jadad评分表进行评估。用RevMan 5.0软件进行Meta分析。结果:在113篇相关文献中,共5个随机对照研究符合全部纳入标准。术后并发症共有4个研究报道296例病人中发生的51起术后并发症,合并相对风险度(RR)=1.05,95%CI为0.64,1.72(P=0.85),两组并发症风险无显著性差异(P>0.05)。住院时间采用随机效应模型合并,合并均数(MD)=-3.04,95%CI为-4.06,-2.03(P<0.01)。肠功能恢复时间共有5个研究报道356例病人肛门恢复排气时间。FTS组与对照组比,肠道功能恢复时间缩短约1 d。共有3个研究报道236例病人的住院费用,与对照组比,FTS组病人总住院费用约减少2 850元。结论:胃肠道恶性肿瘤手术病人接受围术期FTS干预,可缩短术后胃肠功能恢复时间和住院时间,减少住院治疗费用。但对降低病人术后的并发症则不明显。

Objective ： This （FFS） on clinical outcomes in gas base, CNKI,VIP were searched for study aimed to systematically trointestinal randomized cancer patients. control trials that review the influence of fast tract surgery Methods： Chinese Biomedicine Data-published after January 2007. Bibliogra-phies of retrieved papers and personal file were searched as well. The only difference between the inter-vention and control groups was whether the patient received FTS intervention. Methodological quality as-sessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5. 0. 1 and Modified Jadadg Score Scale. RevMan 5.0 statistical software was used for meta-analysis. Results ： Five trials met all the inclusion criteria and were enrolled for final meta-analysis. The aggregated results of the trails showed that patients in the fast track surgery group had no more complications than those in non-fast track group [ relative risk = 1.05,95% CI （0.64, 1.72）, P = 0.85 ]. There was heterogeneity when comparing the intervention groups with traditional ones on length of hospital stay （I2 = 0.84, P 〈 0. 000 1 ）. The result in the former showed a shortening of hospital stay by 3days [ mean difference, MD = -3.04,95% CI（ -4.06, -2.03）, P 〈 0. 000 01 ]. There was heterogeneity when comparing the two groups on length of gastrointestinal recovery （ 12 = 0.80, P = 0. 000 5 ） , and the result of patients in fast track group was lower than that in the control group by about 1 day [ mean difference, MD = - 0.95, 95% CI（ -1.36, -0.53）,P 〈 0.01 ]. In addition,there was heterogeneity among studies on the treat- ment expenses（ I^2 = 0.83,P = 0. 003） , which for patients in FTS decreased significantly by about 2,850 Yuan [ mean difference, MD = - 1746.35,95% CI（ - 2736.54,756.16） ,P = 0. 000 5 ]. Conclusion ： The administration of fast track surgery in surgical patients with gastrointestinal cancer operation improves outcomes. The cost of hospitalization may be significantly lower and length of gastrointestinal recovery and hospitalization may be significantly reduced for patients treated with FTS. Further well-designed random-ized controlled trials are needed to demonstrate the effect of decreasing complications in postoperative patients with gastrointestinal cancer.