混合营养与肠外营养对食管癌术后患者临床疗效比较的Meta分析

A Meta-analysis of Multi-nutrition versus Parenteral Nutrition on Esophagus Cancer Patients after Esophagectomy

目的:系统评价混合营养(MN)与肠外营养(PN)支持对食管癌术后患者的临床疗效。方法:计算机检索英文数据库PubMed、EMbase、The Cochrane Library;中文数据库中国知网、维普、万方等,查找关于MN对比PN支持的食管癌术后患者的随机对照试验(RCT),检索时限截至2018年5月。由2位研究者按标准独立筛选文献、提取资料并评价偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入15个RCT,共1 514例患者。Meta分析结果显示:与PN相比,MN能提高食管癌患者术后白蛋白、前白蛋白、转铁蛋白水平,缩短术后肛门恢复排气时间、住院时间,降低肺部感染和切口感染的发生率;但吻合口瘘的发生率、消化道症状发生率,两组差异无统计学意义(P>0.05)。结论:与PN相比,MN能提高食管癌术后患者的营养状况,降低并发症的发生率。

Objective: To evaluate the clinical efficacy of multi-nutrition (MN) and parenteral nutrition (PN) for perioperative esophagus cancer patients by meta-analysis. Methods: Published randomized controlled trials (RCTs) on comparison between MN and PN for esophagus cancer patients after esophagectomy were retrieved by searching PubMed, EMbase, the Cochrane Library, Web of Science, WanFang Data and CNKI. The retrieval period was from the database construction to May 31, 2018. Two reviewers independently screened literature based on the inclusion and exclusion criteria, extracted data and evaluated bias risks of included studies. Then meta-analysis was performed by using the RevMan 5.3 software. Results: Data from 15 RCTs with 1514 patients were included in this meta-analysis. The results showed that MN could improve postoperative levels of albumin, prealbumin and transferrin compared with PN. Furthermore, the restore time of anal exhaust and postoperative hospital staying were declined with MN. The incidences of pulmonary infection and wound infection after surgery were also decreased with MN. However, there was no significant difference in incidence of anastomotic leakage and gastrointestinal symptoms between the two groups. Conclusion: MN could extensively improve the nutritional level of esophageal cancer patients after esophagectomy, and reduce the incidence of postoperative complications.