加速康复外科与传统康复方案在肝切除术中应用比较的Meta分析

摘要

目的 评价加速康复外科(ERAS)与传统康复方案在肝切除术中的应用效果.方法 文献检索到2016年8月,在PubMed、EBSCO、MEDLINE及Cochrane数据库中检索ERAS与传统康复方案在肝脏外科中应用效果比较的文献,2名单独观察者根据纳入与排除标准进行质量评价与数据提取后,采用RevMan5.3.5软件进行Meta分析.结果 共纳入4篇文献,共524例患者,其中254例为ERAS组,270例为传统治疗组.ERAS组术后住院时间明显优于传统治疗组[加权均数差(WMD)=-2.72,95％可信区间(95％CI):-3.86～-1.57,P＜0.000 01];ERAS组功能恢复时间明显早于传统治疗组(WMD=-2.67,95％ CI:-3.68～-1.65,P＜ 0.000 01);ERAS组总并发症发生率明显少于传统治疗组[比值比(OR) =0.45,95％CI:0.30 ～ 0.67,P＜0.0001],亚组分析1级并发症及2～5级并发症的发生率ERAS组也具有明显优势(OR=0.55,95％CI:0.31 ～0.98,P＜0.05;OR=0.49,95％CI:0.32 ～0.76,P ＜0.05);2组再住院率比较无统计学意义(P＞0.05);术后1d及3dC反应蛋白含量2组比较差异无统计学意义(P值均＞0.05),而术后5 d ERAS组C反应蛋白含量明显小于传统治疗组(WMD=-21.68,95％CI:-29.30～-14.05,JP＜0.000 1);ERAS组术后第1次排气时间明显早于传统治疗组(WMD=-0.93,95％CI:-1.41～-0.46,P=0.000 1).结论 ERAS在肝脏外科中的应用是安全、有效且可行的.%Objective To investigate the effect of enhanced recovery after surgery (ERAS) versus traditional rehabilitation program in patients undergoing hepatectomy.Methods PubMed,EBSCO,MEDLINE,and Cochrane Library were searched for the articles on the effect of ERAS versus traditional rehabilitation program in liver surgery published up to August 2016.Two independent observers performed quality assessment and data extraction according to the inclusion and exclusion criteria,and RevMan 5.3.5 was used for the Meta-analysis.Results A total of 4 articles with 524 patients (254 patients in ERAS group and 270 in traditional treatment group) were included.Compared with the traditional treatment group,the ERAS group had significantly shorter length of postoperative hospital stay (weighted mean difference [WMD] =-2.72,95％ confidence interval [C I]:-3.86 to-1.57,P ＜ 0.000 01),shorter time to functional recovery (WMD =-2.67,95％ CI:-3.68 to-1.65,P ＜ 0.000 01),and lower overall incidence rate of complications (odds ratio [OR] =0.45,95％ CI:0.30 -0.67,P ＜0.000 1).The subgroup analysis showed that the ERAS group also had significantly lower incidence rates of grade 1 and grade 2-5 complications than the traditional treatment group (grade 1:OR =0.55,95％ CI:0.31-0.98,P ＜ 0.05;grade 2-5:OR =0.49,95％ CI:0.32 0.76,P ＜ 0.05).There was no significant difference in rehospitalization rate between the two groups (P ＞ 0.05).As for the level of C-reactive protein,there was no significant difference between the two groups at 1 and 3 days after surgery (P ＞ 0.05),but the ERAS group had a significantly lower level than the traditional treatment group at 5 days after surgery (WMD =-21.68,95％ CI:-29.30 to-14.05,P ＜ 0.000 1).The ERAS group also had a significantly shorter time to first flatus than the traditional treatment group (WMD =-0.93,95％ CI:-1.41 to-0.46,P=0.000 1).Conclusion ERAS is safe,effective,and feasible in liver surgery.