加速康复外科理念在肝切除围术期中应用效果的meta分析

Effect of fast track surgery in perioperative period of hepatectomy:A meta analysis

目的系统评价加速康复外科(FTS)对肝切除患者的安全性和有效性。方法检索PubMed、Web of Science、Cochrane Library、中国知网、万方和维普数据库,检索时间为建库至2019年5月。由两名研究者按照纳入和排除标准筛选文献并提取需行择期开腹或腹腔镜肝切除术患者的数据,FTS组采用FTS管理,传统组采用传统围术期管理;然后采用RevMan 5.3软件进行meta分析。结果最终纳入28篇文献共3452例患者,其中FTS组1632例,传统组1820例;随机对照试验(RCT)研究14篇,临床对照试验(CCT)研究14篇。meta分析结果显示,与传统组比较,FTS可减轻患者术后24 h和48 h疼痛[24 h:WMD=–0.92,95%CI(–1.05,–0.79),P<0.00001;48 h:WMD=–0.73,95%CI(–0.90,–0.56),P<0.00001],降低肺部并发症、总并发症和恶心呕吐发生率[肺部并发症:OR=0.51,95%CI(0.32,0.81),P=0.005;总并发症:OR=0.57,95%CI(0.38,0.87),P=0.008;恶心呕吐:OR=0.45,95%CI(0.31,0.65),P<0.0001],缩短术后首次排气时间[WMD=–17.36,95%CI(–23.16,–11.56),P<0.00001]和住院时间[WMD=–2.42,95%CI(–3.02,–1.63),P<0.00001],减少住院费用[WMD=–0.52,95%CI(–0.64,–0.41),P<0.00001];进一步对RCT和CCT研究进行分析得出的结论基本与总体研究结论一致(除CCT研究中未发现2组的术后肺部并发症发生率比较差异有统计学意义外)。结论从本meta分析结果得到的研究结果看,FTS应用于肝切除患者是安全、有效的,可促进患者术后康复,节约医疗资源。

Objective To systematically evaluate safety and effectiveness of using fast track surgery(FTS)protocol in perioperative management of hepatectomy.Methods The studies were collected by searching the PubMed,Web of Science,Cochrane Library,CNKI,Wanfang Data,and VIP databases by two researchers.The FTS management was used in the FTS group and the traditional perioperative management was used in the traditional group.The meta analysis was performed using the RevMan 5.3 software.Results A total of 28 articles were included in the study,of which 1632 patients in the FTS group and 1820 patients in the traditional group;14 RCTs,14 CCTs.The results of meta analysis showed:Compared with the traditional group,the FTS not only could reduce the pain of patients during 24 and 48 hours after the surgery[24 h:WMD=–0.92,95%CI(–1.05,–0.79),P<0.00001;48 h:WMD=–0.73,95%CI(–0.90,–0.56),P<0.00001],but also shorten the first postoperative flatus time of patients[WMD=–17.36,95%CI(–23.16,–11.56),P<0.00001]and the length of hospital stay[WMD=–2.42,95%CI(–3.02,–1.63),P<0.00001]and reduce the hospitalization expenses[WMD=–0.52,95%CI(–0.64,–0.41,P<0.00001];While the incidences of pulmonary complications[OR=0.51,95%CI(0.32,0.81),P=0.005],total complications[OR=0.57,95%CI(0.38,0.87),P=0.008],and nausea and vomiting[OR=0.45,95%CI(0.31,0.65),P<0.0001]were significantly decreased.The RCT group and CCT group showed the same conclusions with the overall study(except incidence of postoperative pulmonary complications between the two groups in the CCT study).Conclusion For patients with elective hepatectomy,it seems feasible to use FTS protocol,which could promote postoperative bowel recovery,shorten length of hospital day,and save medical resources.