加速康复外科在胰十二指肠切除术围手术期应用有效性和安全性的系统评价与Meta分析

朱琳; 杨小李; 刘莉; 胥兰婷; 冷远洪; 陈静

doi:10.3969/j.issn.1001-5256.2022.06.026

加速康复外科在胰十二指肠切除术围手术期应用有效性和安全性的系统评价与Meta分析

DOI: 10.3969/j.issn.1001-5256.2022.06.026

朱琳¹,
杨小李^{1, 2},
刘莉¹,
胥兰婷¹,
冷远洪¹,
陈静^1, , ,

1.
西南医科大学附属医院肝胆外科，四川泸州 646000
2.
四川省院士(专家)工作站，四川泸州 646000

基金项目:

国家自然科学基金 (81802778)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：朱琳、杨小李、刘莉负责课题设计，收集数据，资料分析和撰写论文; 胥兰婷、冷远洪参与修改论文; 陈静负责指导撰写文章并最终定稿。

详细信息

通信作者:
陈静， 791697074@qq.com

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出版历程
- 收稿日期: 2021-10-12
- 录用日期: 2021-12-20
- 出版日期: 2022-06-20

Efficacy and safety of enhanced recovery after surgery in the perioperative period of pancreaticoduodenectomy: A systematic review and Meta-analysis

Lin ZHU¹,
Xiaoli YANG^{1, 2},
Li LIU¹,
Lanting XU¹,
Yuanhong LENG¹,
Jing CHEN^{1
, ,
,}

1.
Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
2.
Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan 646000, China

Research funding:

National Natural Science Foundation of China (81802778)

More Information

Corresponding author: CHEN Jing, 791697074@qq.com(ORCID: 0000-0002-2075-1659)

摘要

摘要: 目的系统评价加速康复外科(ERAS)在胰十二指肠切除术(PD)围手术期应用的有效性和安全性。方法检索中、英文数据库中有关ERAS应用于PD的临床对照研究，检索时间限定为2000年—2021年。对文献进行筛选、质量评价和数据提取，最后采用RevMan5.3软件进行Meta分析。本研究已在PROSPERO注册，注册号为: CRD42021287931。结果共纳入22项临床对照研究，包含3511例患者。结果显示，在PD围手术期实施ERAS，与传统术后管理相较，可减少患者总并发症(OR=0.63，95%CI：0.48~0.83，P=0.001)、腹腔感染(OR=0.65，95%CI：0.47~0.88，P=0.005)、肺部并发症(OR=0.57，95%CI：0.42~0.78，P=0.000 5)、胰漏(OR=0.80，95%CI：0.67~0.97，P=0.02)、胃排空障碍(OR=0.58，95%CI：0.48~0.71，P＜0.001)的发生率，并可有效减少术后住院时间(MD=-2.76，95%CI：-3.36~-2.16，P＜0.001)，差异均有统计学意义。但在病死率、切口感染、术后出血率、再次手术和再次入院等方面，两组差异均无统计学意义(P值均＞0.05)。结论 ERAS应用于PD围手术期具有较好的有效性及安全性，可显著减少患者术后并发症的发生率和术后住院时间。
- 加速康复外科 /
- 胰十二指肠切除术 /
- Meta分析
Abstract: Objective To investigate the efficacy and safety of enhanced recovery after surgery (ERAS) in the perioperative period of pancreaticoduodenectomy (PD). Methods Chinese and English databases were searched for controlled clinical trials on the application of ERAS in PD published from 2000 to 2021. Screening, quality assessment, and data extraction were performed for the articles, and RevMan5.3 software was used for meta-analysis. This study was registered on PROSPERO with a registration number of CRD42021287931. Results A total of 22 controlled clinical trials were included, with 3531 patients in total. The results showed that the implementation of ERAS in the perioperative period of PD reduced the incidence rates of total complications (odds ratio [OR]=0.63, 95% confidence interval [CI]: 0.48-0.83, P=0.001), abdominal infection (OR=0.65, 95% CI: 0.47-0.88, P=0.005), pulmonary complications (OR=0.57, 95% CI: 0.42-0.78, P=0.000 5), pancreatic leakage (OR=0.80, 95% CI: 0.67-0.97, P=0.02), and delayed gastric emptying (OR=0.58, 95% CI: 0.48-0.71, P < 0.001) and effectively shortened the length of postoperative hospital stay (mean difference=-2.76, 95% CI: -3.36 to -2.16, P < 0.001). However, there were no significant differences between the two groups in mortality rate, incision infection, postoperative bleeding rate, reoperation, and rehospitalization (all P > 0.05). Conclusion ERAS has good efficacy and safety in the perioperative period of PD and can significantly reduce the incidence rates of postoperative complications and shorten the length of postoperative hospital stay. Therefore, it holds promise for clinical application.
- Enhanced Recovery After Surgery /
- Pancreaticoduodenectomy /
- Meta-Analysis

HTML全文

图 1 文献筛选流程图

Figure 1. The flow chart of literature screening

下载: 全尺寸图片幻灯片

图 2 两组患者病死率比较的森林图

Figure 2. Forest plot for the comparison of mortality between the two groups of patients

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图 3 两组患者总并发症发生率比较的森林图

Figure 3. Forest plot for the comparison of the total complication rates between the two groups of patients

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图 4 两组患者腹腔感染发生率比较的森林图

Figure 4. Forest plot for the comparison of the incidence of abdominal infection between the two groups of patients

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图 5 两组患者切口感染发生率比较的森林图

Figure 5. Forest plot for the comparison of the incidence of incision infection between the two groups of patients

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图 6 两组患者肺部并发症发生率比较的森林图

Figure 6. Forest plot for the comparison of the incidence of pulmonary complications between the two groups of patients

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图 7 两组患者胰漏发生率比较的森林图

Figure 7. Forest plot for the comparison of the incidence of pancreatic fistula between the two groups of patients

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图 8 两组患者术后出血发生率比较的森林图

Figure 8. Forest plot for the comparison of the incidence of postoperative bleeding between the two groups of patients

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图 9 两组患者术后胃排空障碍发生率比较的森林图

Figure 9. Forest plot of the incidence of postoperative delayed gastric emptying in the two groups of patients

下载: 全尺寸图片幻灯片

图 10 两组患者术后住院时间比较的森林图

Figure 10. Forest plot for the comparison of postoperative hospital stay in the two groups

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图 11 两组患者再次手术发生率比较的森林图

Figure 11. Forest plot for the comparison of the incidence of reoperation between the two groups of patients

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图 12 两组患者再次入院发生率比较的森林图

Figure 12. Forest plot for the comparison of the incidence of readmission between the two groups of patients

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图 13 术后出血率的发表偏倚分析

Figure 13. Analysis of publication bias for postoperative bleeding rates

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图 14 胰漏的发表偏倚分析

Figure 14. Analysis of publication bias for pancreatic fistula

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表 1 纳入文献基本特征及质量评价

Table 1. Basic characteristics and quality evaluation of the included

作者	年份	国家	研究类型	例数		男/女 (例)	年龄(岁) (ERAS组/Control组)	NOS/Jadad质量评分(分)
作者	年份	国家	研究类型	ERAS组	Control组	男/女 (例)	年龄(岁) (ERAS组/Control组)	NOS/Jadad质量评分(分)
Aviles等^[12]	2017	中国	RCS	40	140	98/82	58±13/57±12	9
Dai等^[13]	2017	中国	RCS	68	98	85/81	58.5(18~69)/59.2(14~83)	8
Deng等^[14]	2017	中国	RCT	76	83	92/67	54.5±12.7/51.3±15.0	5
Hwang等^[15]	2019	韩国	RCT	123	124	153/94	63.3±9.2/62.9±9.2	4
Kapritsou等^[16]	2020	希腊	RCT	44	41	52/33	60.5±11.7/64.8±11.9	6
Kowalsky等^[17]	2019	美国	RCS	123	131	134/120	68.2±9.8/66.3±10.4	8
Lavu等^[18]	2019	美国	RCT	37	39	38/38	65.8±9.6/65.0±9.3	6
Lof等^[19]	2020	英国	RCS	250	125	214/161	65±10.9/66±9.7	8
Partelli等^[20]	2016	意大利	RCS	22	66	47/41	77(75~82)/77.5(75~82)	7
Pineda-Solis等^[21]	2020	美国	RCS	48	56	48/56	66.7±8.6/61.8±13.5	8
Shao等^[22]	2015	中国	RCS	325	310	378/257	56.9±11.5/57±12	8
Su等^[23]	2017	中国	RCS	31	31	37/25	62±9/61±11	8
Takagi等^[24]	2019	日本	RCT	37	37	40/34	67.8±9.7/66.8±9.3	4
Williamsson等^[25]	2015	瑞典	RCS	50	50	57/43	69(15~80)/67(25~81)	8
Zhu等^[26]	2019	中国	RCS	64	69	59/74	64.3±7.9/64.1±11.5	8
Zouros等^[27]	2016	希腊	RCS	75	50	80/45	65.9±10.5/63.9±11.6	9
曹昕彤等^[28]	2021	中国	RCS	32	69	55/46	55(27~76)/56(38~81)	7
李向阳等^[29]	2016	中国	RCS	15	39	36/18	52.7(41~71)/56.6(35~77)	8
梁琦等^[30]	2018	中国	RCS	64	58	68/54	56.3±6.7/54.7±7.9	7
纪柏等^[31]	2019	中国	RCS	50	50	48/52	57.0±14.2/59.3±15.3	8
范闻等^[32]	2018	中国	RCS	51	176	130/97	56.8±1.6/58.2±0.9	8
蔡云强等^[33]	2016	中国	RCS	41	23	38/26	54±5/52±6	8
注：RCS，回顾性临床研究。

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