对加速康复外科应用于结直肠癌围手术期Meta分析的方法学质量再评价

Reevaluation of the methodological quality in meta-analyses of accelerated rehabilitation on recovery after surgery for colorectal cancer

目的评价加速康复外科应用于结直肠癌围手术期系统评价/Meta分析的方法学质量及其对结局的影响。方法系统检索PubMed等6个电子数据库中的Meta分析、系统评价或荟萃分析，检索时限均从建库至2016年7月。用OQAQ量表评价纳入研究的方法学质量；用Cochrane协作网的推荐工具和NOS量表分别评价RCT、CCT和观察性研究的方法学质量；用Review Manager 5.3软件整合Meta分析的RR值及其95% CI。结果共纳入14个Meta分析，其OQAQ平均得分3.8分[95% CI（3.2，4.3）]；3个研究可认为只有小缺陷，方法学质量评为Good，2个研究错用统计学模型。纳入的42个原始研究中，25个RCT质量为B级，1个CCT质量为C级，16个观察性研究的NOS（总分9分）平均得分6.75分[95% CI（6.4，7.1）], 10个研究得分≥7分，质量较高；6个得6分，质量中等。结论目前针对结直肠癌围手术期患者应用加速康复外科理念的Meta分析的总体质量较差，证据水平较低，使用这些证据来指导临床决策时尚需谨慎。

ObjectiveTo evaluate the methodological quality and impacts on outcomes for systematic reviews （SRs） of accelerated rehabilitation versus traditional control for colorectal surgery.MethodsWe comprehensively searched six databases and additional websites to collect SRs, or meta-analysis from inception to July 2016. The Overview Quality Assessment Questionnaire （OQAQ） was applied for quality assessment of the included studies, the tools recommended by the Cochrane Collaboration was applied for quality assessment for RCT and CCT and the Newcastle-Ottawa Scale （NOS） was applied to assess observational study. The relative ratios （RRs） and 95% confidence intervals （CIs） were integrated using Review Manager 5.3 software.ResultsFourteen meta-analyses were included in total. The mean OQAQ score was 3.8 with 95% CI 3.2 to 4.3. Only three meta-analyses were assessed as good quality. Two studies misused statistical models. A total of 42 primary studies referenced by meta-analyses were included, of which, 25 RCTs were levelled grade B and 1 CCT was levelled grade C. An estimated mean NOS score of 16 observation studies was 6.75 （totally scored 9 with 95% CI 6.4 to 7.1）, of which, 10 studies scored ≥7 were high quality, 6 studies scored 6 were moderate quality.ConclusionsCurrently, the overall quality of meta-analyses about comparing the effects and safety between accelerated rehabilitation and traditional control for colorectal surgery is fairly poor and the evidence level is lower. Health providers should apply the evidence with caution in clinical practice.