加速康复外科理念在肝切除术围手术期应用的Meta分析

任龙; 张淼; 张云

doi:10.3969/j.issn.1001-5256.2018.03.025

加速康复外科理念在肝切除术围手术期应用的Meta分析

DOI: 10.3969/j.issn.1001-5256.2018.03.025

江苏大学附属宜兴医院普外科

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中图分类号: R657.3
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出版历程
- 出版日期: 2018-03-20

Application of enhanced recovery after surgery in perioperative period of hepatectomy: a Meta-analysis

Department of General Surgery, The Affiliated Yixing Hospital of Jiangsu University

摘要

摘要:
目的系统评价加速康复外科理念在肝切除术围手术期的应用价值。方法检索Pub Med、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和数据提取,应用Revman 5.3软件进行Meta分析。结果共纳入17篇文献,其中随机对照试验14篇,半随机对照试验3篇。共收集2220例患者,其中加速康复组1002例,对照组1218例。相比于对照组,加速康复组术后住院时间[加权均数差（WMD）=-2.58,95%置信区间（95%CI）:-3.47-1.70,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[标准化均数差（SMD）=-1.56,95%CI:-2.15-0.97,P<0.05]均缩短;并发症发生率降低[比值比（OR）=0.64,95%CI:0.520.78,P<0.05];住院费用明显减少（SMD=-0.85,95%CI...
- 加速康复外科 /
- 肝切除术 /
- 手术期间 /
- Meta分析
Abstract:
Objective To systematically review the value of enhanced recovery after surgery ( ERAS) in the perioperative period of hepatectomy. Methods A literature search was conducted in Pub Med, Embase, Cochrane Library, Sinomed, Wanfang Data, VIP, and CNKI to identify the articles on the application of ERAS in the perioperative period of hepatectomy published up to July 2017. Quality evaluation and data extraction were performed for the included articles. A Meta-analysis was performed using Revman 5. 3 software. Results A total of 17 articles were included, with 14 randomized controlled trials and 3 controlled clinical trials. A total of 2220 patients were involved and divided into ERAS group ( n = 1002) and control group ( n = 1218) . Compared with the control group, the ERAS group had significantly shortened length of postoperative hospital stay ( weighted mean difference [WMD]=-2. 58, 95% confidence interval [CI]:-3. 47 to-1. 70, P<0. 05) , functional rehabilitation time ( WMD =-3. 39, 95% CI:-4. 32 to-2. 45, P < 0. 05) , and time to first flatus ( standardized mean difference [SMD]=-1. 56, 95% CI:-2. 15 to-0. 97, P < 0. 05) , as well as reduced complication rate ( odds ratio [OR]= 0. 64, 95%CI: 0. 52-0. 78, P < 0. 05) and hospital costs ( SMD =-0. 85, 95% CI:-1. 23 to-0. 47, P < 0. 05) . There were no significant differences between the two groups in readmission rate ( OR = 1. 28, 95% CI: 0. 69-2. 69, P >0. 05) , operation time ( WMD =-11. 36, 95% CI:-23. 25 to 0. 53, P > 0. 05) , and intraoperative blood loss ( WMD =-22. 62, 95% CI:-38. 89 to-6. 34, P > 0. 05) . Conclusion ERAS is safe and effective in the perioperative period of hepatectomy and holds promise for clinical application.
- enhanced recovery after surgery /
- hepatectomy /
- intraoperative period /
- Meta-analysis

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参考文献(27)

[1]KEHLET H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth, 1997, 78 (5) :606-617.

[2]LIANG X, YING H, WANG H, et al.Enhanced recovery program versus traditional care in laparoscopic hepatectomy[J].Medicine, 2016, 95 (8) :e2835.

[3]NI CY, YANG Y, CHANG YQ, et al.Fast-track surgery improves postoperative recovery in patients undergoing partialhepatectomy for primary liver cancer:a prospective randomized controlled trial[J].Eur J Surg Oncol, 2013, 39 (6) :542-547.

[4]LIN D, LI X, YE Q, et al.Implementation of a fast-trackclinical pathway decreases postoperative length of stay and hospital charges for liver resection[J].Cell Biochem Biophys, 2011, 61 (2) :413-419.

[5]van DAM RM, HENDRY PO, COOLSEN MM, et al.Initial experience with a multimodal enhanced recovery programmein patients undergoing liver resection[J].Br J Surg, 2008, 95 (8) :969-975.

[6]CLARK CJ, ALI SM, ZAYDFUDIM V, et al.Safety of an enhanced recovery pathway for patients undergoing open hepatic resection[J].PLo S One, 2016, 11 (3) :e150782.

[7]STOOT JH, van DAM RM, BUSCH OR, et al.The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery:a multicentre pilot study[J].HPB (Oxford) , 2009, 11 (2) :140-144.

[8]HE F, LIN X, XIE F, et al.The effect of enhanced recoveryprogram for patients undergoing partial laparoscopic hepatectomy of liver cancer[J].Clin Transl Oncol, 2015, 17 (9) :694-701.

[9]WANG YP, LIU HC, HUANG W, et al.Application of enhanced recovery after surgery in the perioperative period of patients undergoing hepatectomy[J].Chin J Gen Surg, 2017, 32 (3) :243-246. (in Chinese) 王远鹏, 刘会春, 黄伟, 等.加速康复外科理念在肝癌切除围手术期的应用研究[J].中华普通外科杂志, 2017, 32 (3) :243-246.

[10]CHENG Y, JIA WD, XU GL, et al.Application of the concept of enhanced recovery after surgery in the perioperative period of hepatectomy for hepatocellular carcinoma[J/CD].Chin J Hepat Surg:Electronic Edition, 2017, 6 (3) :187-191. (in Chinese) 程亚, 荚卫东, 许戈良, 等.加速康复外科理念在肝细胞癌肝切除围手术期中的应用[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (3) :187-191.

[11]PENG L, WANG K, FAN YW, et al.Application value of enhanced recovery concept in perioperative management ofhepatectomy for primary liver cancer[J].Chin J Gen Surg, 2017, 26 (2) :218-222. (in Chinese) 彭浪, 王恺, 樊友文, 等.加速康复外科理念在原发性肝癌肝切除术围手术期管理的应用价值[J].中国普通外科杂志, 2017, 26 (2) :218-222.

[12]LUO PF, JIA WD, XU GL, et al.Clinical pathway of enhanced recovery after surgery in patients undergoing hepatectomy for primary liver cancer[J].Chin J Gen Surg, 2015, 30 (11) :862-865. (in Chinese) 骆鹏飞, 荚卫东, 许戈良, 等.加速康复外科理念在原发性肝癌患者肝切除围手术期中的应用[J].中华普通外科杂志, 2015, 30 (11) :862-865.

[13]WANG LX, ZHAO ZQ, TAN HT, et al.Clinical application of enhance recovery after surgery in patients with hepatocellular carcinoma underwent liver resection[J].Int J Surg, 2016, 43 (4) :249-254. (in Chinese) 王龙鑫, 赵战强, 谭宏涛, 等.加速康复外科在肝癌肝切除术中的临床应用研究[J].国际外科学杂志, 2016, 43 (4) :249-254.

[14]ZHANG CG, WANG QB, ZHANG GD, et al.Application of fast track surgery in hepatolobectomy[J].Chin J Pract Med, 2011, 38 (15) :33-36. (in Chinese) 张传国, 王庆宝, 张广东, 等.加速康复外科在肝叶切除术中的应用[J].中国实用医刊, 2011, 38 (15) :33-36.

[15]DING W, ZHANG F, LI GQ, et al.Application of fast tracksurgery in perioperative management of patients with hepatic cancer[J].Chin J Gen Surg, 2013, 22 (1) :32-36. (in Chinese) 丁蔚, 张峰, 李国强, 等.快速康复理念在肝癌肝切除术围手术期处理中的应用[J].中国普通外科杂志, 2013, 22 (1) :32-36.

[16]SHOU ZX, ZHENG DW, LUO YX, et al.Value of fast track surgery principles in the perioperative management of liver cancer patients after hepatectomy[J].Chin J Dig Surg, 2014, 13 (6) :456-460. (in Chinese) 首志雄, 郑达武, 罗永香, 等.快速康复外科理念在肝癌肝切除术围手术期管理中的临床价值[J].中华消化外科杂志, 2014, 13 (6) :456-460.

[17]FAN XJ, TAN HY, XIAO YM, et al.Application of fast track surgery in perioperative management of patients with primary hepatic cancer[J].Chin J Gen Surg, 2011, 20 (7) :683-686. (in Chinese) 樊献军, 谭黄业, 肖咏梅, 等.快速康复外科理念在肝癌围手术期处理中的应用[J].中国普通外科杂志, 2011, 20 (7) :683-686.

[18]ZHENG JL, WANG ZG, YOU ZJ, et al.Application research of fast track surgery in perioperative patients with hepatocellular carcinoma[J].Chin J Surg Oncol, 2015, 7 (5) :273-277. (in Chinese) 郑惊雷, 王在国, 游志坚, 等.快速康复外科在肝癌围手术期的应用研究[J].中国肿瘤外科杂志, 2015, 7 (5) :273-277.

[19]DONG JH.Precision liver surgery[J].Chin J Dig Surg, 2014, 13 (6) :405-411. (in Chinese) 董家鸿.精准肝脏外科[J].中华消化外科杂志, 2014, 13 (6) :405-411.

[20]WANG C, ZHENG G, ZHANG W, et al.Enhanced recoveryafter surgery programs for liver resection:a meta-analysis[J].J Gastrointest Surg, 2017, 21 (3) :472-486.

[21]CHEN H, ZHANG D, PAN F, et al.Enhanced recovery after surgery in perioperative management of hepatectomy:a Meta-analysis[J].Chin J Hepatobiliary Surg, 2016, 22 (6) :361-366. (in Chinese) 陈虎, 张栋, 潘飞, 等.快速康复外科在肝切除围手术期应用的Meta分析[J].中华肝胆外科杂志, 2016, 22 (6) :361-366.

[22]FIORE JJ, FARAGHER IG, BIALOCERKOWSKI A, et al.Time to readiness for discharge is a valid and reliable measure of short-term recovery after colorectal surgery[J].World J Surg, 2013, 37 (12) :2927-2934.

[23]VARADHAN KK, NEAL KR, DEJONG CH, et al.The en hanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery:a meta-analysis of randomized controlled trials[J].Clin Nutr, 2010, 29 (4) :434-440.

[24]LASSEN K, COOLSEN MM, SLIM K, et al.Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced Recovery After Surgery (ERAS (R) ) Society recommendations[J].Clin Nutr, 2012, 31 (6) :817-830.

[25] Chinese Medical Doctor Association, Chinese Committee of Biliary Surgeons.Expert consensus on enhanced recovery after surgery for biliary surgery (2016 edition) [J].Chin J Dig Surg, 2017, 16 (1) :6-13. (in Chinese) 中国医师协会外科医师分会胆道外科医师委员会.胆道手术加速康复外科专家共识 (2016版) [J].中华消化外科杂志, 2017, 16 (1) :6-13.

[26]Chinese Research Hospital Association, Society for Hepatopancreatolbiliary Surgery.Expert consensus on enhanced recovery after hepatobiliary&pancreatic surgery (2015 edition) [J].J Clin Hepatol, 2016, 32 (6) :1040-1045. (in Chinese) 中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识 (2015版) [J].临床肝胆病杂志, 2016, 32 (6) :1040-1045.

[27]HUANG XH, HU HZ, JIANG Y.Clinical value of enhanced recovery after surgery in radical resection of hepatocellular carcinoma[J].Chin J Dig Surg, 2017, 16 (2) :164-169. (in Chinese) 黄兴华, 胡还章, 江艺.加速康复外科在肝细胞癌根治术中的临床价值[J].中华消化外科杂志, 2017, 16 (2) :164-169.

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