加速康复外科对胰十二指肠切除术后胃排空障碍影响的Meta分析

Effect of enhanced recovery after surgery on delayed gastric emptying after pancreaticoduodenectomy:a meta-analysis

目的系统评价加速康复外科(ERAS)用于胰十二指肠切除术(PD)对术后胃排空障碍(DGE)的影响。…方法通过检索中、英文数据库,收集有关PD中应用ERAS的符合纳入标准的随机对照研究(RCT)和高质量病例对照研究(CCT)文献,采用Meta分析进行系统评价。检索时间为2008年1月~2018年1月。结果共收集符合纳入标准的文献24篇,累计3723例患者,其中应用ERAS者1765例(ERAS组),应用传统围手术期方法(CPC)者1958例(CPC组)。Meta分析结果显示:两组手术时间[MD=-15.47,95%CI(-37.49,6.56),P=0.17]、术后胰瘘发生率[OR=0.87,95%CI(0.74,1.02),P=0.09]、术后再入院率[OR=1.00,95%CI(0.78,1.27),P=0.99]、术后再手术率[OR=0.87,95%CI(0.63,1.21),P=0.41]、术后近期死亡率[OR=0.94,95%CI(0.58,1.54),P=0.82]差异均无统计学意义。与CPC组相比,ERAS组术后住院时间短[MD=-3.87,95%CI(-4.60,-3.15),P<0.00001],术后胃排空障碍发生率低[OR=0.51,95%CI(0.42,0.62),P<0.00001],住院费用减少。结论PD围手术期应用ERAS安全、可行,ERAS可降低PD术后胃排空障碍的发生风险。

Objective To systematically evaluate the effect of enhanced recovery after surgery on delayed gastric emptying after pancreaticoduodenectomy.Methods By searching the Chinese and English databases,RCT and CCT articles about ERAS applicated in PD that met the inclusion criteria from Jan 2008 to Jan 2018 were collected,and meta-analysis was used for systematic evaluation.Results The study included 3723 patients which met the inclusion criteria.The ERAS were used in 1765 patients(ERAS group),and the CPC were used in 1958 patients(CPC group).Meta-analysis showed that there was no significant difference in operation time[MD=-15.47,95%CI(-37.49,6.56),P=0.17],incidence of postoperative pancreatic fistula[OR=0.87,95%C(I 0.74,1.02),P=0.09],postoperative readmission rate[OR=1.00,95%CI(0.78,1.27),P=0.99],postoperative reoperation rate[OR=0.87,95%CI(0.63,1.21),P=0.41],short-term postoperative mortality[OR=0.94,95%CI(0.58,1.54),P=0.82]between the two groups.Compared with the CPC group,the ERAS group had shorter postoperative hospitalization stay[MD=-3.87,95%CI(-4.60,-3.15),P<0.00001],lower postoperative gastric emptying rate[OR=0.51,95%CI(0.42,0.62),P<0.00001],less hospital costs.Conclusion Peri-operative application of ERAS in PD is safe and feasible.ERAS can reduce the risk of delayed gastric emptying after pancreaticoduodenectomy.