加速康复外科在胰十二指肠切除术中应用安全性评价的Meta分析

Safety of fast track surgery in pancreaticoduodenectomy: a Meta-analysis

目的胰十二指肠切除术是普外科最复杂的手术之一,本研究旨在评估加速康复外科在胰十二指肠切除术中应用的安全性及有效性。方法通过计算机系统检索中文数据库、外文数据库有关加速康复外科在胰十二指肠切除术中应用的文献,检索时间自1994年1月至2016年4月,由两位研究者对符合纳入标准的文献进行质量评价并提取数据。采用Stata12.0软件对手术后总并发症发生率、胰漏发生率、消化道排空障碍发生率进行分析,运用Begg秩相关检验及Egger线性回归法检验发表偏倚情况。结果加速康复外科组术后总并发症发生率低于传统组,差异有统计学意义[风险比(RR)=0.748,95%可信区间(95%CI):0.680~0.824,P<0.001],胰漏发生率的比较两组间差异无统计学意义(RR=0.894,95%CI:0.734~1.089,P=0.266),加速康复外科组消化道排空障碍发生率低于传统组,差异有统计学意义(RR=0.520,95%CI:0.400~0.670,P<0.001)。结论加速康复外科在胰十二指肠切除术中的应用是安全、有效的,但加速康复外科中的一些措施在胰十二指肠切除术中的应用仍需更多的循证医学证据支持。

Objective To investigate the safety and clinical effect of fast track surgery in pancreaticoduodenectomy,one of the most complex surgeries in general surgery.Methods The Chinese and foreign databases were searched for articles on the application of fast tract surgery in pancreaticoduodenectomy published from January 1994 to April 2016.Two researchers evaluated the quality of the articles which met the inclusion criteria and extracted related data.Stata 12.0 software was used to analyze the overall incidence rate of complications and the inci-dence rates of pancreatic leakage and gastrointestinal emptying disorder,and the Begg rank correlation test and Egger linear regression meth-od were used to investigate publication bias.Results The fast track surgery group had a significantly lower overall incidence rate of compli-cations than the conventional group （RR =0.748,95%CI：0.680 -0.824,P 〈0.001）.There was no significant difference in the inci-dence rate of pancreatic leakage between the two groups （RR =0.894,95%CI：0.734 -1.089,P =0.266）.The fast track surgery group had a significantly lower incidence rate of gastrointestinal emptying disorder than the conventional group （RR =0.520,95%CI：0.400 -0. 670,P 〈0.001）.Conclusion Fast track surgery is safe and effective in pancreaticoduodenectomy,but the application of some measures in fast track surgery still needs more medical evidence.