加速康复外科在腹腔镜肝切除术围手术期应用的Meta分析

摘要

目的:系统评价加速康复外科(enhanced recovery after surgery,ERAS)理念在腹腔镜肝切除术围手术期的应用价值.方法:检索PubMed、Embase、Cochrane图书馆、SinoMed、万方、维普、中国知网等数据库,文献检索起止时间均从建库至2017年7月.对纳入文献进行质量评价与数据提取,应用RevMan 5.3软件进行Meta分析.结果:纳入9篇文献,其中随机对照研究2篇,病例对照研究7篇;共收集694例患者,其中ERAS组354例,对照组340例.相较对照组,ERAS组住院时间(WMD=-2.55,95％CI:-2.95～-2.15,P<0.05)、功能康复时间(WMD=-3.39,95％CI:-4.32～-2.45,P<0.05)、首次排气时间(SMD=-1.56,95％CI:-2.41～-0.71,P<0.05)均缩短;并发症发生率降低(OR=0.40,95％CI:0.27～0.60,P<0.05);住院费用明显减少(SMD=-1.00,95％CI:-1.55～-0.44,P<0.05);而手术时间(WMD=-4.29,95％CI:-17.62～9.05,P>0.05)、术中出血量(WMD=-22.09,95％CI:-70.52～26.35,P>0.05)差异无统计学意义.结论:快速康复外科理念应用于腹腔镜肝切除术围手术期是安全、有效的,值得推广.%Objective:To conduct a system review on the application value of enhanced recovery after surgery ( ERAS) in peri-operative period of laparoscopic hepatectomy. Methods:A literature search was conducted on the databases which included the PubMed,Embase,Cochrane library,SinoMed,Wanfang,VIP and CNKI about the application of ERAS in patients of hepatectomy. The retrieval time was from inception to Jul. 2017. Meta analysis was performed using RevMan 5. 3 software. Results:Nine articles were in-cluded,of which 2 were randomized controlled trials and 7 were case control trials. A total of 694 patients were collected,of whom 354 cases were in ERAS group and 340 cases were in the control group. Compared with the control group,the hospitalization time ( WMD=-2. 55,95％CI:-2. 95～-2. 15,P<0. 05),functional rehabilitation time (WMD=-3. 39,95％CI:-4. 32～-2. 45,P<0. 05) and the first exhaust time (SMD=-1. 56,95％CI:-2. 41～-0. 71,P<0. 05) of the ERAS group were significantly shortened;The complication rate of ERAS group decreased (OR=0. 40,95％CI:0. 27～0. 60,P<0. 05). The hospitalization expenses of ERAS group were obviously re-duced (SMD=-1. 00,95％CI:-1. 55～-0. 44,P<0. 05). There was no significant difference in operation time (WMD=-4. 29,95％CI:-17. 62～9. 05,P>0. 05) and intraoperative bleeding (WMD=-22. 09,95％CI:-70. 52～26. 35,P>0. 05). Conclusions:The applica-tion of ERAS in perioperative period of laparoscopic hepatectomy is safe,effective and worthy of promotion.