上消化道重建术后鼻饲与空肠造口置管肠内营养临床效果比较的Meta分析

Clinical effectiveness of nasojejunal feeding vs.jejunostomy for enteral nutrition in patients undergoing major upper gastrointestial reconstruction:A Meta-analysis

目的系统评价经鼻肠内营养管(NJT)与空肠造口置管(JT)两种不同营养途径在上消化道改建术后病人肠内营养的临床效果。方法计算机检索PubMed、EMbase、Web of science、The Cochrane Library(2015年第9期)、中国生物医学文献数据库(CBM)、中国知网、维普、万方数据等数据库,查找所有比较术后NJT与JT行肠内营养的上腹部肠道改建手术的随机对照试验(RCT),检索时限为从建库至2015年9月。由2位研究者按纳入与排除标准独立筛选文献、提取资料和评价文献质量后,进行Meta分析。结果最终纳入7个RCT,包括544例病人。Meta结果显示:虽然JT组术后总并发症发生率少于NJT组[RR=0.58,95%CI(0.38,0.90),P=0.02],但与管道相关并发症发生率两组差异无统计学意义[RR=1.30,95%CI(0.93,1.81),P=0.12];两组肠内营养置管后不能耐受发生率差异无统计学意义[RD=-0.08,95%CI(-0.20,0.03),P=0.16];术后主要并发症吻合口漏及肺炎两组差异无统计学意义(P>0.05);肠功能恢复时间JT组明显短于NJT组[SMD=-1.19,95%CI(-1.77,-0.60),P<0.0001],两组比较差异有统计学意义。结论两种肠内营养途径均是安全有效的方法,但JT在促进肠功能恢复和减少术后总并发症方面更有优势。

Objective To systematically review the clinical effectiveness of nasojejunal tube （NJT） vs. jejunostomy tube （JT） for enteral nutrition in patients undergoing major upper gastrointes- tial reconstruction. Methods We electronically searched The PubMed, The EMbase, Web of science, The Cochrane Library （Issue 9, 2015）, CBM, CNKI, VIP and WanFang Data for randomized con- trolled trials （RCTs） about NJT vs. JT on patients after major upper gastrointestinal reconstruction. The duration of search was from the inception of the databases to September 2015. After literature se- lection, data extraction and quality assessment were conducted by two reviewers independently, and meta-analysis was done using Revman 5. 2 software. Results Seven studies involving 544 patients were finally included. The results of Meta-analysis showed the total postoperative complications be- tween JT group and NJT group had no significant differences [RR = 0. 58, 95% CI （0. 38, 0. 90）, P -0. 02], and there was significant difference in the feeding-tube-related complications between two groups [RR = 1.30, 95% CI （0. 93, 1.81）, P = 0. 12]. The rate of not tolerating the enteral nutri- tional catheter had no significant difference [RD = - 0. 08, 95 % CI （ - 0. 20, 0. 03）, P = 0. 16]. The recovery time of bowel movement in JT group was shorter than in NJT group [SMD = - 1.19, 95% CI （ - 1.77, - 0. 60）, P〈0. 0001], but the incidence of pneumonia and anastomotic leakage had no significant difference between the two groups （P〉0. 05）. Conclusions Both the two routes of enteral nutrition are safe and effective, but in the effect of improving the bowel movement and total postopera- tive complications, JT is more satisfactory than NJT.