针刺治疗结直肠癌术后胃肠功能障碍疗效的系统评价和Meta分析

Clinical efficacy of acupuncture in treating postoperative gastrointestinal dysfunction of colorectal cancer,a systematic review and Meta analysis

目的:运用Meta分析评价针刺治疗结直肠癌术后胃肠功能障碍的疗效。方法:检索PubMed、Embase、Cochrane Library、中国知网数据库、万方学术期刊全文数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库7个数据库中针刺治疗结直肠癌术后胃肠功能障碍的随机对照试验,时间为建库至2022年11月10日。利用Cochrane偏倚风险评估工具及改良的Jadad量表评价纳入文献的质量。应用RevMan 5.4进行Meta分析,应用Stata 16.0进行回归分析及偏倚风险分析,采用TSA 0.9软件进行试验序贯分析。结果:研究共纳入27项随机对照试验,共2 629例患者。干预措施包括手针、电针、经皮穴位电刺激、温针、揿针。结果显示针刺治疗可缩短患者术后首次耐受流质饮食时间(MD=-13.70,95%CI=[-17.94,-9.46],P<0.000 01)、首次排便时间(MD=-18.20,95%CI=[-22.62,-13.78],P<0.000 01)、首次排气时间(MD=-16.31,95%CI=[-20.32,-12.31],P<0.000 01)、首次肠鸣音恢复时间(MD=-11.91,95%CI=[-14.01,-9.81],P<0.000 01)、住院天数(MD=-1.49,95%CI=[-2.27,-0.70],P=0.000 2)。回归分析结果显示癌症类型、文献质量及针刺次数是异质性的主要来源。偏倚分析显示可能存在一定发表偏倚风险。试验序贯分析显示研究已满足所需病例数,结论可靠。结论:针刺治疗是结直肠癌患者术后胃肠功能的有效恢复措施,未来仍需要大样本量及严格设计的临床研究比较不同针刺方法的疗效。

Objective To evaluate the efficacy of acupuncture in the treatment of postoperative gastrointestinal dysfunction(POGD)of colorectal cancer.Methods Randomized controlled trials of acupuncture in the treatment of POGD were retrieved from 7 databases including PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,VIP Chinese Journal Service Platform,WanFang Data Knowledge Service Platform,and China Biology Medicine disc.The search period ranged from the inception of the databases to November 10~(th),2022.The quality of the included literature was assessed using the Cochrane bias risk assessment tool and the modified Jadad scale.Meta analysis was conducted using RevMan 5.4.Regression analysis and bias risk analysis were performed using Stata 16.0.Trial sequential analysis was conducted using TSA 0.9 software.Results A total of 27 randomized controlled trials involving 2629 patients were included.Intervention measures included manual acupuncture,electroacupuncture,transcutaneous acupoint electrical stimulation,warm acupuncture,and thumb-tack needle.The results showed that acupuncture treatment significantly reduced time to tolerance of liquid diet after surgery(MD=-13.70,95%CI=[-17.94,-9.46],P<0.00001),time to first defecation(MD=-18.20,95%CI=[-22.62,-13.78],P<0.00001),time to first flatus(MD=-16.31,95%CI=[-20.32,-12.31],P<0.00001),time to bowel sounds recovery(MD=-11.91,95%CI=[-14.01,-9.81],P<0.00001),and length of hospital stay(MD=-1.49,95%CI=[-2.27,-0.70],P=0.0002).Regression analysis indicated that cancer type,study quality and number of acupuncture were the main sources of heterogeneity.Bias analysis suggested potential publication bias risks.Trial sequential analysis indicated that the required number of cases had been met and the conclusion was reliable.Conclusion Acupuncture is an effective intervention for promoting gastrointestinal recovery in patients undergoing colorectal cancer surgery.Further large-sample and well-designed clinical trials are still needed to compare different acupuncture techniques.