加速康复外科在胰腺切除围手术期应用的安全性Meta分析

Enhanced recovery after surgery programs in the perioperative safety of pancreatic surgery： a Metaanalysis

目的评价加速康复外科（ERAS）在胰腺切除围手术期应用的安全性。方法利用计算机检索1995年1月至2017年8月万方、CNKI、维普、PubMed、Cochrane Library、Embase、Sciencedirect数据库有关胰腺切除围手术期实施ERAS措施的随机对照试验、病例对照研究。由两名研究者分别对符合纳入标准的研究进行质量评价和数据提取，采用RevMan5．3．5对术后各项指标进行Meta分析。结果分析共纳入4项随机对照试验和21项病例对照研究。纳入分析的4063例患者中ERAS组2052例，对照组（采取传统围手术期管理）2011例。与对照组相比，ERAS组术后并发症发生率降低（OR=0．57，95％CI：0．45～0．71，P〈0．05），术后胃排空障碍（DGE）发生率降低（OR=0．46，95％CI：0．37—0．59，P〈0．05），术后腹腔感染发生率降低（OR=0．68，95％CI：0．53-0．88，P〈0．05）、术后住院时间缩短（WMD=-4．86，95％CI：-6．10～-3．62，P〈0．05），术后重症监护病房（ICU）住院时间缩短（WMD=-1．04，95％CI：-2．01--0．08，P〈0．05）。两组患者术后胰瘘发生率（POPF,OR=0．89，95％CI：0．74—1．04，P〉0．05）、再入院率（OR=1．04，95％CI：0．83—1．30，P〉0．05）和术后病死率差异无统计学意义（OR=0．84，95％CI：0．53—1．33，P〉0．05）。结论胰腺切除围手术期实施加速康复外科措施是安全可行的，可以减少术后并发症，促进患者恢复。

Objective To evaluate the safety of enhanced recovery after surgery （ERAS） programs in pancreas surgery. Methods A computer search was performed on databases which included the Wanfang, CNKI, VIP, PubMed, Cochrane Library, Embase and Seieneedirect for randomized controlled trials or case -control studies on ERAS programs in pancreatic surgery published between January 1995 and August 2017. Two researchers independently evaluated the quality of the studies which met the inclusion criteria and performed a meta - analysis using the RevMan5.3.5 software. Results Four randomized controlled trials and twenty one case-control studies which included 4 063 patients entered into the meta-analysis. These patients included the ERAS group （ n = 2 052 ） and the control group （ n = 2 011 who underwent traditional perioperative management）. Compared with the control group, the ERAS group had a lower postoperative complication rate （OR =0.57, 95% CI： 0. 45 -0.71, P 〈0.05）, a lower delayed gastric emptying rate （ OR = 0. 46, 95 % CI： 0. 37 - 0. 59, P 〈 0. 05 ） , a lower abdominal infection rate （ OR = 0. 68, 95% CI： 0. 53 - 0. 88, P 〈 0. 05 ）, a shorter hospital stay （ WMD = - 4.86, 95% CI： - 6.10 - - 3.62, P 〈 0.05 ） and intensive care stay （ WMD = - 1.04, 95 % CI： - 2. 01 - - 0.08, P 〈 0.05 ）. No significant differences existed in the mortality, readmission and postoperative pancreatic fistula rates between the two groups. Conclusion Perioperative implementation of ERAS programs was safe and effective in pancreatic surgery, and decreased postoperative complication rates and promoted recovery.