早期肠内营养在胰十二指肠切除术后应用的安全性与可行性Meta分析

Meta-analysis of safety and feasibility of early enteral nutrition after pancreaticoduodenectomy

目的采用Meta分析探讨早期肠内营养(early enteral nutrition,EEN)在胰十二指肠切除术(pancreaticoduodenectomy,PD)术后应用的短期临床疗效。方法检索多个国内外数据库公开发表的关于PD术后营养支持的文献。检索时间为建库至2022年9月,纳入文献类型定为随机对照试验(randomized controlled trial,RCT)。采用RevMan 5.3软件进行数据分析。结果纳入8项RCT研究,共935例患者。Meta分析结果显示:与其他营养组比较,EEN组总体并发症发生率更低(OR=0.91,95%CI:0.54~1.52,P=0.71),但差异无统计学意义(P>0.05);病死率(OR=0.98,95%CI:0.41~2.32,P=0.96)、胰瘘发生率(OR=1.04,95%CI:0.49~2.21,P=0.92)、胆瘘发生率(OR=1.58,95%CI:0.43~5.77,P=0.49)、胃排空延迟(delayed gastric emptying,DGE)发生率(OR=0.95,95%CI:0.68~1.33,P=0.78)、术后出血发生率(OR=1.03,95%CI:0.55~1.92,P=0.93)、总体感染发生率(OR=0.75,95%CI:0.53~1.05,P=0.09)、腹腔感染发生率(OR=0.81,95%CI:0.56~1.16,P=0.25)、肺部感染(OR=0.54,95%CI:0.15~2.00,P=0.36)、住院时间(length of stay,LOS)(OR=–1.32,95%CI:–2.74~0.10,P=0.07)组间比较,差异均无统计学意义(P>0.05)。亚组分析结果提示,管饲方式可能是术后总体并发症发生率(P=0.002)、病死率(P=0.003)、DGE(P=0.04)、LOS(P=0.01)的亚组间异质性因素之一(P<0.05)。结论EEN在PD术后短期疗效方面是安全可靠的。受研究数量与质量限制,上述结论尚待更多高质量研究予以验证。

Objective Meta-analysis is used to evaluate the short-term clinical effect of early enteral nutrition(EEN)after pancreaticoduodenectomy(PD).Methods Literature were indexed by several domestic and foreign databases for published research on nutritional support after PD.The time was from the establishment of the database to September 2022,and the included literature was randomized controlled trial(RCT).The data were analyzed following Meta-analysis method using RevMan 5.3.Results Totally 8 RCTs were included,with a total of 935 patients.Meta-analysis showed that the overall complication rate of EEN was lower than that of other nutritional methods(OR=0.91,95%CI:0.54~1.52,P=0.71),but there was no statistical significance(P>0.05).The analysis showed no significant differences between the EEN and other nutrition group in mortality(OR=0.98,95%CI:0.41~2.32,P=0.96),pancreatic fistula(OR=1.04,95%CI:0.49~2.21,P=0.92),biliary fistula(OR=1.58,95%CI:0.43~5.77,P=0.49),delayed gastric emptying(DGE)(OR=0.95,95%CI:0.68~1.33,P=0.78),postoperative bleeding(OR=1.03,95%CI:0.55~1.92,P=0.93),systemic infection(OR=0.75,95%CI:0.53~1.05,P=0.09),abdominal infection(OR=0.81,95%CI:0.56~1.16,P=0.25),pulmonary infection(OR=0.54,95%CI:0.15~2.00,P=0.36),and length of stay(LOS)(OR=–1.32,95%CI:–2.74~0.10,P=0.07).Subgroup analysis showed that tube feeding mode might be one of the sources of heterogeneity among subgroups(P<0.05)in overall postoperative complication rate(P=0.002),mortality rate(P=0.003),DGE(P=0.04),LOS(P=0.01).Conclusion The short-term effect of EEN after PD may be safe and feasible.Limited by the number and quality of studies,the above conclusions need to be verified by more high-quality studies.