空肠造瘘管对比鼻空肠营养管在食管癌根治术后行肠内营养的疗效与安全性的系统评价与Meta分析

Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer:A systematic review and meta-analysis

目的系统评价空肠造瘘管对比鼻空肠营养管行肠内营养在食管癌根治术后的疗效与安全性。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库,搜集关于空肠造瘘管对比鼻空肠营养管行肠内营养在食管癌根治术后的临床效果研究,检索时限均为建库至2021年10月。采用RevMan 5.4软件进行Meta分析。结果最终纳入26篇文献,其中17篇随机对照研究、9篇队列研究,共包含35808例患者。Meta分析结果显示:空肠造瘘管组术后排气时间[MD=–4.27,95%CI(–5.87,–2.66),P=0.001]、肺部感染发生率[OR=1.39,95%CI(1.06,1.82),P=0.02]、脱管发生率[OR=0.11,95%CI(0.04,0.30),P=0.001]、堵管发生率[OR=0.47,95%CI(0.23,0.97),P=0.04]、鼻咽部不适[OR=0.04,95%CI(0.01,0.13),P=0.001]、鼻咽黏膜破损发生率[OR=0.13,95%CI(0.04,0.42),P=0.008]、恶心呕吐发生率[OR=0.20,95%CI(0.08,0.47),P=0.003]均短于或低于鼻空肠营养管组,术后血清白蛋白水平[MD=5.75,95%CI(5.34,6.16),P=0.001]高于鼻空肠营养管组,且差异具有统计学意义。但空肠造瘘管组术中操作时间[MD=13.65,95%CI(2.32,24.98),P=0.02]、术后营养管留置时间[MD=17.81,95%CI(12.71,22.91),P=0.001]长于鼻空肠营养管组,同时其术后肠梗阻发生率[OR=6.08,95%CI(2.55,14.50),P=0.001]高于鼻空肠营养管组,差异具有统计学意义。而两组术后住院时间、吻合口瘘发生率差异无统计学意义(P>0.05)。结论空肠造瘘管在食管癌根治术后行肠内营养过程中,临床治疗效果更佳,置管舒适性更高,但是肠梗阻发生率较传统鼻空肠营养管更高。

Objective To systematically evaluate the efficacy and safety of jejunostomy tube versus nasojejunal tube for enteral nutrition after radical resection of esophageal cancer.Methods PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,Wanfang,VIP and CBM databases were searched to collect the clinical effects of jejunostomy tube versus nasojejunal nutrition tube after radical resection of esophageal cancer from inception to October 2021.Metaanalysis was performed using RevMan 5.4 software.Results Twenty-six articles were included,including 17 randomized controlled studies and 9 cohort studies,with a total of 35808 patients.Meta-analysis results showed that:in the jejunostomy tube group,the postoperative exhaust time(MD=–4.27,95%CI–5.87 to–2.66,P=0.001),the incidence of pulmonary infection(OR=1.39,95%CI 1.06 to 1.82,P=0.02),incidence of tube removal(OR=0.11,95%CI 0.04 to 0.30,P=0.001),incidence of tube blockage(OR=0.47,95%CI 0.23 to 0.97,P=0.04),incidence of nasopharyngeal discomfort(OR=0.04,95%CI 0.01 to 0.13,P=0.001),the incidence of nasopharyngeal mucosal damage(OR=0.13,95%CI 0.04 to 0.42,P=0.008),the incidence of nausea and vomiting(OR=0.20,95%CI 0.08 to 0.47,P=0.003)were significantly shorter or lower than those of the nasojejunal tube group.The postoperative serum albumin level(MD=5.75,95%CI 5.34 to 6.16,P=0.001)was significantly better than that of the nasojejunal tube group.However,the intraoperative operation time of the jejunostomy tube group(MD=13.65,95%CI 2.32 to 24.98,P=0.02)and the indent time of the postoperative nutrition tube(MD=17.81,95%CI 12.71 to 22.91,P=0.001)were longer than those of the nasojejunal nutrition tube.At the same time,the incidence of postoperative intestinal obstruction(OR=6.08,95%CI 2.55 to 14.50,P=0.001)was significantly higher than that of the nasojejunal tube group.There were no statistical differences in the length of postoperative hospital stay or the occurrence of anastomotic fistula between the two groups(P>0.05).Conclusion In the process of enteral nutrition after radical resection of esophageal cancer,jejunostomy tube has better clinical treatment effect and is more comfortable during catheterization,but the incidence of intestinal obstruction is higher than that of traditional nasojejunal tube.