加速康复外科联合中医治疗在胃癌患者中应用的Meta分析

Application of Enhanced Recovery after Surgery Combined with Traditional Chinese Medicine Therapy in Gastric Cancer:a Meta-analysis

目的:应用Meta分析方法评价加速康复外科(ERAS)联合中医治疗对胃癌患者术后康复的影响。方法:通过计算机检索国内外数据库中有关ERAS联合中医治疗对胃癌患者的随机对照试验(RCT)文献,检索时间从建库至2020年6月。根据纳入及排除标准筛选文献后提取数据,采用RevMan 5.3软件进行Meta分析。结果:纳入9篇RCT文献,其中以传统围手术期管理为对照5篇,以ERAS围手术期管理为对照5篇(其中1篇进行了传统围手术期管理、ERAS手术期管理、ERAS结合中医治疗三组对比),总计病例787例,Meta分析结果显示:相较于常规围手术期管理,ERAS结合中医治疗可显著减少术后首次排气排便时间、术后住院时间、术后住院费用、术后胃肠道不良反应和术后泌尿系感染的发生(P<0.05);相较于ERAS围手术期管理,ERAS结合中医治疗可显著减少术后首次排气排便时间(P<0.05),而在术后住院时间、术后胃肠道不良反应发生上的差异无统计学意义(P>0.05);在术后出血、切口感染、肺部并发症、深静脉血栓、吻合口瘘等术后并发症方面,ERAS结合中医治疗的术后并发症发生率相较于常规围手术期管理或是ERAS围手术期管理更低,但差异无统计学意义(P>0.05)。结论:相较于常规围手术期管理和ERAS围手术期管理,ERAS结合中医治疗可促进术后胃肠功能恢复,且安全性较好。

Objective To evaluate the influence of enhanced recovery after surgery(ERAS)combined with Traditional Chinese Medicine(TCM)therapy for postoperative recovery of gastric cancer by Meta-analysis.Methods Through search major domestic and foreign databases to collect theliteratures of randomized controlled trial(RCT)about enhanced recovery after surgery combined with Traditional Chinese Medicine therapy in gastric cancer published by June,2020.To extractdata after screening the literature according to the inclusion and exclusion criteria,and to perform Meta-analysis with RevMan 5.3 software.Results 9 RCT literatures with 787 patients were involved,among them,5 literatures compared with traditional perioperative management and 5 literatures compared with perioperative management of ERAS.The Meta-analysis showed that ERAS combined with TCM therapy has significant advantages compared with conventional perioperative management in the time after surgery about first exhaust,first defecation and hospital stay(P<0.05).Compared with perioperative management of ERAS,ERAS combined with TCM therapy has significant advantages in the time after surgery about first exhaust and first defecation(P<0.05),not in postoperative hospital stay(P>0.05).About postoperative complications,the incidence of postoperative complications of ERAS combined with TCM therapy is lower than that of conventional perioperative management or perioperative management of ERAS,but the difference is not statistically significant(P>0.05).Conclusion Compared with conventional perioperative management and perioperative management of ERAS,ERAS combined with TCM therapy can promote the recovery of gastrointestinal function after surgery,which the safety is positive.