加速康复外科在腹腔镜肝切除术应用安全性与有效性的Meta分析

Meta-analysis on safety and efficacy of application of fast-track surgery in laparoscopic hepatectomy

目的:评价加速康复外科(FTS)在腹腔镜肝切除围手术期应用的安全性和有效性。方法:计算机检索1996年1月—2014年6月国内外数据库有关FTS在腹腔镜肝切除围手术期应用的随机对照试验(RCT)或临床对照试验(CCT),采用RevMan 5.2软件进行Meta分析。结果:最终纳入3项RCT和2项CCT,共有247例患者,其中134例采用FTS(FTS组),113例采用传统围手术期处理(对照组)。Meta分析结果显示,与对照组比较,FTS组住院时间明显缩短(WMD=-2.19,95%CI=-2.94^-1.43,P<0.00001),术后并发症发生率降低(RR=0.60,95%CI=0.38~0.92,P=0.02),但两组手术时间、中转开腹发生率和住院费用无统计学差异(均P>0.05)。结论:FTS在腹腔镜肝切除围手术期应用可有效缩短住院时间,减少术后并发症,加速患者康复。上述结果仍须更多设计严密的大样本、高质量的RCT进一步验证。

Objective： To assess the safety and efficacy of the application of fast-track surgery （FTS） in perioperative management of laparoscopic liver resection. Methods： The randomized controlled trials （RCTs） or clinical controlled trials （CCTs） concerning application of FTS in perioperative management of laparoscopic liver resection were collected by computer-based search of literature published between January 1966 and June 2014 from national and international databases. Meta-analysis was performed by using RevMan 5.2 soft ware. Results： Th ree RCTs and 2 CCTs were fi nally included involving 247 patients, of whom 134 cases received FTS treatment （FTS group） and 113 cases received traditional perioperative care （control group）. Results of Metaanalysis showed that the length of hospital stay was shortened and incidence of postoperative complications was reduced in FTS group compared with control group （WMD=-2.19, 95% CI=-2.94--1.43, P＆lt;0.00001; RR=0.60, 95% CI=0.38-0.92, P=0.02）, while no statistical difference was noted in operative time, open conversion rate and hospitalization costs between the two groups （all P＆gt;0.05）. Conclusion： Application of FTS in perioperative management of laparoscopic hepatectomy can reduce the length of hospital stay and incidence of complications and thereby accelerate postoperative recovery of the patients. However, the above results require further verifi cation by more well-designed RCTs with large sample size and good quality.