快速康复外科在胰十二指肠切除术中应用的有效性和安全性的Meta分析

Efficacy and safety of application of enhanced recovery after pancreaticoduodenectomy surgery (ERAS):a meta-analysis

目的系统评价快速康复外科(ERAS)在胰十二指肠切除术中应用的有效性和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library、CBM、CNKI和VIP数据库,搜集胰十二指肠切除术患者围手术期采用ERAS与传统康复管理比较的临床对照研究,检索时限均从建库至2017年3月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入12个非随机非同期对照研究,包括2 588例患者。Meta分析结果显示:对比传统术后康复,ERAS能缩短胰十二指肠术后患者的住院时间[MD=–5.44,95%CI(–7.73,–3.15),P<0.000 01]、术后首次肛门排气时间[MD=–1.40,95%CI(–2.60,–0.20),P=0.02]、减少术后总并发症发生率[OR=0.61,95%CI(0.52,0.72),P<0.000 01]、胰瘘发生率[OR=0.81,95%CI(0.66,0.99),P=0.04]和胃排空障碍发生率[OR=0.49,95%CI(0.38,0.63),P<0.000 01]。但两组在术后胆瘘、腹腔感染、伤口感染和肺部感染发生率方面,差异均无统计学意义。结论 ERAS应用于胰十二指肠切除术围手术期有效且安全。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of enhanced recovery after pancreaticoduodenectomy surgery（ERAS）. Methods Pub Med, EMbase, The Cochrane library, CBM, CNKI and VIP databases were electronically searched to collect clinical controlled trials of comparing ERAS and the traditional rehabilitation management in patients who received pancreaticoduodenectomy from inception to March 31-（st）, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, metaanalysis was performed by using Rev Man 5.2 software. Results A total of 12 non-randomized historical controlled trials involving 2 588 patients were included. The results of meta-analysis showed that ERAS shortened postoperative hospital stay（MD=–5.44, 95%CI –7.73 to –3.15, P〈0.000 01） and the time to the first passage of flatus（MD=–1.40, 95%CI –2.60 to –0.20, P=0.02）, reduced the rate of postoperative complication（OR=0.61, 95%CI 0.52 to 0.72, P〈0.000 01）,pancreatic fistula（OR=0.81, 95%CI 0.66 to 0.99, P=0.04） and delayed gastric emptying（OR=0.49, 95%CI 0.38 to 0.63,P〈0.000 01）. However, there was no significant difference in incidences of biliary fistula, abdominal cavity infection,wound infection and postoperative pulmonary infection between two groups. Conclusions The application of ERAS in pancreaticoduodenectomy is effective and does not increase postoperative complication. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.