加速康复外科在结直肠癌合并糖尿病患者手术中应用的meta分析

Application of enhanced recovery after surgery programs in colorectal cancer patients with diabetes mellitus:a meta-analysis

目的系统评价加速康复外科(ERAS)在结直肠癌合并糖尿病患者手术中应用的有效性与安全性。方法以主题词“结直肠癌”“结直肠手术”“糖尿病”“加速康复外科”“快速康复外科”检索PubMed、EMBASE、Cochrane Library、中国知网、维普资讯网、万方数据库从建库至2020年11月公开发表的ERAS在结直肠癌合并糖尿病患者手术中应用的文献。筛选符合纳入及排除标准的研究,分为ERAS组(ERAS措施处理)与对照组(常规措施处理),比较两组患者术后肛门排气时间、术后排便时间、住院时间、住院费用、并发症发生率的情况,采用RevMan 5.4软件进行meta分析。结果最终纳入8篇文献,共725例患者,其中ERAS组372例,对照组353例。ERAS组术后肛门排气时间[SMD=-2.20,95%CI(-2.72,-1.69),P<0.00001]、术后排便时间[MD=-1.51,95%CI(-2.09,-0.93),P<0.00001]、住院时间[MD=-3.18,95%CI(-4.36,-2.01),P<0.00001]短于对照组,住院费用[SMD=-0.73,95%CI(-0.98,-0.48),P<0.00001]少于对照组,并发症发生率[OR=0.29,95%CI(0.18,0.49),P<0.00001]低于对照组。结论ERAS在结直肠癌合并糖尿病患者手术中的应用是安全有效的,有利于患者术后肠道功能的恢复,缩短住院时间,减少住院费用,降低并发症的发生率,但仍需更高级别的循证证据支持。

Objective To systematically evaluate the safety and effectiveness of enhanced recovery after surgery(ERAS)in colorectal cancer patients with diabetes mellitus.Methods Based on the key words of“colorectal cancer”“colorectal surgery”“diabetes”“enhanced recovery after surgery”and“fast track surgery”,PubMed,EMBASE,Cochrane Library,CNKI,VIP and Wanfang databases were searched for articles on the application of ERAS in the operation of colorectal cancer patients with diabetes from the establishment of the database to November 2020.Qualified articles were screened out according to the inclusion and exclusion criteria,the patients were divided into ERAS group(ERAS measure processing)and control group(conventional measures treatment).The time to first flatus,time to first defecation,length of hospital stay,hospital charge and incidence of complications were compared between the two groups.Revman 5.4 software was used for meta-analysis.Results A total of 725 patients were included,including 372 patients in the ERAS group and 353 patients in the control group.In ERAS group,the postoperative anal exhaust time(SMD=-2.20,95%CI[-2.72,-1.69],P<0.00001),the postoperative defecation time(MD=-1.51,95%CI[-2.09,-0.93],P<0.00001),the length of hospital stay(MD=-3.18,95%CI[-4.36,-2.01],P<0.00001)were shorter than those in the control group,the hospitalization cost(SMD=-0.73,95%CI[-0.98,-0.48],P<0.00001)was lower than that of the control group,and the incidence of complications(OR=0.29,95%CI[0.18,0.49],P<0.00001)was lower than that of the control group.Conclusion The application of ERAS in colorectal cancer patients with diabetes mellitus is safe and effective,which is conducive to the recovery of postoperative intestinal function,reducing length of stay,hospital charge and incidence of complications,but it still needs higher level evidence-based support.