肝硬化食管胃曲张静脉内镜治疗术后饮食策略与预后的关系:系统评价

Dietary strategies and the relationships with prognosis after endoscopic treatments of gastroesophageal varices in patients with cirrhosis:a systematic review

目的:从初次进食时间、食物性质、进食途径等方面探讨食管胃曲张静脉(GOV)及其出血(EVB)的胃镜下硬化剂/组织粘合剂注射及套扎等治疗术后的饮食策略与预后的关系。方法:选择中、外文数据库(包括CNKI、万方数据、重庆维普、PubMed、Web of science、EMbase,自建库至2019年04月30日),检索GOV/EVB内镜术后与饮食管理相关的随机对照试验的报道,评价其饮食方案与预后指标等的关系,必要时采用RevMan 5.3进行meta分析。结果:通过文献检索共检出文献207篇;其中,8项研究(n=592)被纳入系统评价。经分析得出:内镜术后早期进食(≤8 h)并不增加病人出血风险(OR=0.64,P=0.29)、死亡率和其他并发症的发生率;早期进食可缩短住院时间、改善病人心理状况;术后应首先考虑主动经口饮食,忌食粗硬、适量进食。结论:GOV/EVB内镜治疗术后早期经口的合理进食是总体安全的;有必要增加对术后病人饮食管理的关注、制定科学规范的饮食策略以减少GOV/EVB术后不良事件发生。

Objective:To explore the postoperative dietary strategies and the relationship with prognosis of esophagogastric varices(GOV)and bleeding(EVB)by endoscopic injection sclerotherapy,tissue adhesive injection and ligation from initial feeding time,food,feeding route,etc.Method:CNKI,WanFang,Chongqing VIP,PubMed,EMBASE,and Web of Science,were searched to April 30,2019.Randomized controlled trials(RCTs)with dietary management after endoscopic therapy were enrolled.We evaluated the relationship between dietary regimens and prognosis,and used RevMan 5.3 for meta-analysis if necessary.Results:A total of 207 articles were identified through literature search;Among these,8 studies(n=592)were included in the systematic review.According to the analysis,early feeding(≤8 h)after endoscopic surgery does not increase the risk of rebleeding(OR=0.64,P=0.29),the incidence of mortality and other complications;early feeding can shorten the length of hospitalization,improve the patient's psychological condition;Oral feeding with a soft,moderate amount diet should be considered.Conclusion:Early oral feeding with soft,moderate amount diet is generally safe.More awareness of diet managements,and optimized diet strategies are still needed for reducing the adverse events after GOV/EVB endoscopic treatments.