快速康复外科在开腹肝癌切除术中应用的Meta分析

Meta-analysis of using enhanced recovery after surgery in open hepatectomy for liver cancer

目的:评价在开腹肝癌切除术围手术期应用快速康复外科(ERAS)的安全性、有效性及对患者术后恢复的影响。方法:检索多个国内外数据库收集有关开腹肝癌肝切除中应用ERAS的随机对照研究(RCT),对纳入的文献进行质量评价和数据提取后,应用RevMan5.3软件进行Meta分析。结果:最终纳入RCT研究16篇,1770例患者,其中ERAS组888例,对照组882例。Meta结果显示,与对照组比较,ERAS组术后并发症的发生率明显降低(MD=0.47,95%CI=0.35～0.63,P<0.001);术后首次排气时间明显缩短(SMD=-3.64,95%CI=-4.72～2.56,P<0.001);术后第3、7天丙氨酸氨基转移酶水平(MD=-50.23,95%CI=-59.35～-41.11,P<0.001;MD=-37.48,CI=-42.19～-32.78,P<0.001)与术后第1、3天C-反应蛋白水平(MD=-38.64,95%CI=-61.14～-16.14,P<0.001;MD=-26.75,95%CI=-46.03～-7.47,P<0.01)均明显降低;术后住院时间(MD=-2.71,95%CI=-3.86～-1.55,P<0.001)和总住院时间(MD=-2.86,95%CI=-4.11～-1.62,P<0.001)及住院费用(MD=-1.20,95%CI=-1.84～-0.57,P<0.05)均明显减少。结论:开腹肝癌切除术围术期实施ERAS方案安全、有效,有利于患者术后恢复,减少住院时间和降低医疗费用。

Objective:To evaluate the safety and effectiveness of using enhanced recovery after surgery(ERAS)protocols during the perioperative period of open liver cancer resection and the influence on postoperative recovery of the patients.Methods:The randomized controlled trials(RCTs)concerning using ERAS in open liver cancer resection were collected by searching several national and international databases.After the quality assessment and data extraction of the included studies,Meta-analysis was performed by using ReMan5.3 software.Results:Sixteen RCTs were finally included,involving 1 770 patients with 888 cases in ERAS group and 882 cases in control group.The results of Meta-analysis showed that in ERAS group compared with control group,the incidence of postoperative complications was significantly reduced(MD=0.47,95%CI=0.35–0.63,P<0.001);the time to first postoperative gas passage was shortened(SMD=–3.64,95%CI=–4.72–2.56,P<0.001);the levels of alanine aminotransferase on postoperative day(POD)3 and 7(MD=–50.23,95%CI=–59.35––41.11,P<0.001;MD=–37.48,CI=–42.19––32.78,P<0.001),and the levels of C-reactive protein on POD 1 and 3(MD=–38.64,95%CI=–61.14––16.14,P<0.001;MD=–26.75,95%CI=–46.03––7.47,P<0.01)were all significantly decreased;the length of postoperative hospital stay(MD=–2.71,95%CI=–3.86––1.55,P<0.001)and total hospital stay(MD=–2.86,95%CI=–4.11––1.62,P<0.001)as well as the hospitalization cost(MD=–1.20,95%CI=–1.84––0.57,P<0.05)were all significantly reduced.Conclusion:The implementation of ERAS programs in the perioperative period of open liver cancer resection is safe and effective,can accelerate postoperative recovery,and reduce hospital stay and medical costs of the patients.