加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析

Enhanced recovery after surgery(ERAS)for abdominal wall reconstruction:A systematic review and meta-analysis

目的通过对现有文献进行系统评价和Meta分析,比较加速康复外科护理方案与常规护理方案对腹壁重建手术的影响。方法本文作者利用PubMed、EMBASE和Cochrane数据库,查找了与腹壁重建手术ERAS方案相关的研究,检索时限为建库至2020年4月。分析比较ERAS方案与常规护理方法对患者的住院时长、肠道功能恢复、术后并发症以及再入院率的影响。结果分析纳入了4项回顾性队列研究,共涉及患者768人(ERAS组345人,常规护理组423人)。相较于常规护理组,ERAS方案缩短了患者的住院时长[平均差(MD)-0.93(-1.83~-0.04),P=0.04],促进了肠道功能早期恢复[MD-0.86(-1.12~-0.60),P<0.0001]。ERAS组与常规护理组患者术后并发症以及再入院率相近。结论在腹壁重建手术中应用ERAS方案有可能缩短平均住院时长、加快肠道功能恢复。未发现ERAS组和常规护理组患者的并发症发生率和再入院率差异有统计学意义。为证实ERAS方案的优越性,并做进一步优化,需进行大规模随机对照试验。

Objective To compare the influence of ERAS care on postoperative recovery with that of conventional care in abdominal wall reconstruction,we performed a systematic review and meta-analysis based on current literature.Methods PubMed,EMBASE and Cochrane were searched for studies published before April 2020 containing original data on the ERAS program for abdominal wall reconstruction.The effects of ERAS protocols and conventional care on length of stay(LOS),bowel recovery,postoperative complications and readmission were compared.Results Four retrospective cohort studies with a total of 768 patients(345 in ERAS and 423 in the conventional care group)were identified.LOS was shorter with ERAS than with conventional care[mean difference(MD)-0.93(-1.83--0.04),P=0.04].ERAS patients had an earlier return of bowel function than the control[MD,-0.86(-1.12--0.60);P<0.0001].Postoperative complications and readmission were comparable between the ERAS and conventional care groups.Conclusion The application of ERAS protocols in abdominal wall reconstruction surgery may reduce the average length of hospital stay and accelerate the recovery of bowel function.No statistically significant differences were found in the incidence of complications and readmission rates between the ERAS and conventional care groups.To further confirm the advantages of ERAS protocols and optimize them,large-scale randomized controlled trials are needed.