早期经口进食对食管癌病人术后并发症和康复疗效影响的Meta分析

Meta-analysis of the effects of early oral feeding on postoperative complications and rehabilitation of patients with esophageal cancer

目的:探讨早期经口进食(early oral feeding,EOF)与延迟经口进食(late oral feeding,LOF)对食管癌术后病人的可行性与安全性。方法:通过计算机检索PubMed、Medline、Embase、The Cochrane Library、Web of Science、万方、中国知网、维普、中国生物医学文献数据库,查找关于EOF与LOF食管癌术后病人的随机对照试验(randomized controlled trial,RCT),检索时限为数据库建库至2021年10月。2名研究员按照纳入与排除标准对文献进行筛选,质量评价与资料提取后采用RevMan 5.3软件进行Meta分析。结果:最终纳入6篇文献,共713例病人。Meta分析结果显示,食管癌病人术后EOF可明显缩短术后首次排气时间[MD=-1.58,95%CI(-2.30,-0.85),P<0.0001]、排便时间[MD=-1.75,95%CI(-2.62,-0.87),P<0.0001]和术后住院时间[MD=-2.99,95%CI(-3.07,-2.90),P<0.00001],但对术后吻合口瘘发生率[RR=0.97,95%CI(0.54,1.72),P=0.91]、肺部感染发生率[RR=0.70,95%CI(0.47,1.04),P=0.08]、乳糜胸发生率[RR=0.30,95%CI(0.08,1.10),P=0.07]无明显影响。结论:食管癌术后EOF能缩短病人术后首次排气、排便时间和术后住院时间,促进病人康复,但对术后并发症发生率无明显影响。

Objective:To explore the feasibility and safety of early oral feeding(EOF)and late oral feeding(LOF)for postoperative patients with esophageal cancer.Methods:To search randomized controlled trial(RCT)about EOF and LOF in postoperative patient with esophageal cancer through computer retrieval of PubMed,Medline,Embase,The Cochrane Library,Web of Science,Wanfang,CNKI,VIP,and Chinese BioMedical Literature Database.The retrieval period was from the establishment of the database to October 2021.Two researchers screened the literature according to inclusion and exclusion criteria.After quality evaluation and data extraction,meta-analysis was performed using RevMan 5.3 software.Results:A total of 6papers with a total of 713 patients were included.The results of meta-analysis showed that in patients with esophageal cancer,EOF can significantly shorten the first postoperative exhaust time[MD=-1.58,95%CI(-2.30,-0.85),P<0.0001],and defecation time[MD=-1.75,95%CI(-2.62,-0.87),P<0.0001]and postoperative hospitalization time[MD=-2.99,95%CI(-3.07,-2.90),P<0.00001],but it has no significant effect on the incidence of postoperative anastomotic fistula[RR=0.97,95%CI(0.54,1.72),P=0.91],the incidence of pulmonary infection[RR=0.70,95%CI(0.47,1.04),P=0.08]and the incidence of chylothorax[RR=0.30,95%CI(0.08,1.10),P=0.07].Conclusion:After the operation of esophageal cancer,EOF can shorten the time of first postoperative exhaust,defecation and postoperative hospital stay,and promote the recovery of patients,but has no significant effect on the incidence of postoperative complications.