胃癌根治术快速康复外科随机对照试验的Meta分析

Fast track surgery in radical gastrectomy for gastric cancer : a meta-analysis of randomized controlled trials

目的系统评价快速康复外科(fast track surgery,FTS)在胃癌根治术中应用的安全性及有效性。方法检索1990年1月至2013年12月Pubmed、Embase、Cochrane Library、CNKI、万方、维普等数据库有关胃癌根治术应用FTS的随机对照试验(ramdomized controlled trials,RCT),提取相关数据资料后采用Revman5.2.0软件进行Meta分析。结果共纳入11篇RCT,1 079例患者。结果显示,快速康复组术后C反应蛋白CRP水平显著低于传统组(SMD=-0.83,P<0.05)。术后首次排气时间及术后住院时间均较传统组缩短,加权均数差(WMD)分别为-22.96、-2.07,均P<0.05。术后并发症发生率差异无统计学意义(RR=0.87,P>0.05)。老年患者中,快速康复组术后首次排气时间、术后住院时间均短于传统组,WMD值分别为-29.05、-2.75(P值均<0.05),术后并发症发生率低于传统组(RR=0.41,P<0.05)。FTS内部,腹腔镜组术后首次排气时间及术后住院时间短于开腹组,WMD分别为-9.16、-1.11,均P<0.05,术后并发症发生率差异无统计学意义(RR=0.95,P>0.05)。结论个体化合理应用FTS能有效缓解胃癌根治术患者的应激反应,加速康复,不增加术后并发症,是安全有效的,在患者年龄上没有禁忌,应用腹腔镜技术更能体现FTS的优势。

Objective To assess the safety and effectiveness of fast track surgery(FTS) in radical gastrectomy for gastric cancer. Methods Pubmed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases were searched to collect randomized controlled trials(RCTs) which used FTS in radical gastrectomy for gastric cancer from January 1990 to July 2014, data were extracted for meta-analysis by using Revman 5.2.0 software. Results Eleven RCTs with a total of 1,079 patients were included. Compared with the traditional group, the level of CRP was significantly lower(SMD=-0.83,P<0.05), the time to the first exhaust was reduced(WMD =-22.96,P <0.05) and postoperative hospital stay was shortened(WMD =-2.07,P <0.05) in the FTS group, but no significant difference in complication rate was found between the two groups(RR =0.87,P >0.05). In elderly patients, the time to first exhaust(WMD =-29.05,P <0.05),postoperative hospital stay(WMD=-2.75,P<0.05) and complication rate were significantly lower in the FTS group(RR =0.41, P <0.05). Within FTS group, laparoscopic subgroup had earlier flatus(WMD =-9.16,P <0.05) and shorter postoperative hospital stay(WMD =-1.11,P <0.05), no significant difference in complication rate was found between the laparoscopic and open subgroups. Conclusions FTS can relieve postoperative stress response and accelerate rehabilitation in patients undergoing gastrectomy for gastric cancer, with no more complications. FTS is safe and effective, and age is not a contraindication, and it's advantages could be reflected better by using laparoscopic techniques.