结直肠癌术后肠内营养与肠外营养有效性、安全性的Meta分析

Efficacy and safety of enteral nutrition and parenteral nutrition after resection of colorectal cancer:a Meta-analysis

目的采用Meta分析的方法评价结直肠癌患者术后早期肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)的有效性及安全性。方法计算机检索PubMed、EmBase、Cochrane Library、中国生物医学文献数据库(CBM)、知网、维普、万方数据库,纳入结直肠癌患者术后EN与PN比较的随机对照试验(RCTs)。检索时间从建库至2019年5月1日,按纳入及排除标准由2位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析。结果共纳入12个RCTs,涉及行结直肠癌切除术后患者1608例。Meta分析结果显示,结直肠癌患者术后早期EN(试验组)与PN(对照组)相比,术后首次排气时间、术后血清白蛋白、术后总胆红素、术后住院时间、术后CD4+/CD8+、术后感染发生率、术后吻合口瘘发生率差异均有统计学意义;而术后血清总蛋白、术后前白蛋白、术后腹胀发生率、术后腹泻发生率差异无统计学意义。结论早期EN能够缩短排气时间和住院时间,促进胃肠功能尽早恢复,并可改善患者的营养水平,减少相关并发症的发生,提高患者的免疫功能,具有一定的临床推广价值。

Objective To evaluate the efficacy and safety of early enteral nutrition(EN)and parenteral nutrition(PN)after resection of colorectal cancer.Methods The databases including PubMed,EmBase,Cochrane Library,CBM,CNKI,VIP and WanFang were electronically searched,and the randomized controlled trials(RCTs)of EN and PN after resection of colorectal cancer from the establishment of the databases to May 1st 2019 were collected according to the inclusive and exclusive criteria.The quality of the included trials was assessed,and the data were extracted and analyzed by RevMan 5.3.The whole process was done by two trained researchers separately.Results A total of 12 RCTs involving 1608 colorectal cancer patients were included,and the early EN(the experiment group)and PN(the control group)were compared.Meta-analysis showed that there were significant differences in the time to first flatus,postoperative serum albumin,postoperative bilirubin,the length of postoperative hospital stay,postoperative CD4+/CD8+,the incidence of postoperative complication of infection,postoperative anastomotic leakage,and there were no significant differences in postoperative serum protein,postoperative prealbumin,the incidence of postoperative diarrhea and the incidence of postoperative abdominal distension.Conclusion Early EN can shorten the time of flatus and the length of hospital stay,promot the early recovery of gastrointestinal function and nutritional level of patients,reduce related complication,improve the immune function of patients,which has certain clinical promotion value.