加速康复外科理念在胰十二指肠切除围手术期应用的系统评价  

Application of enhanced recovery after surgery program in perioperative management of pancreaticoduodenectomy：a systematic review

作　　者：雷秋成[1] 王新颖[1] 谈善军[1] 万晓[1] 郑华珍[2] 李宁[1] 

机构地区：[1]南方医科大学南京临床医学院南京军区南京总医院解放军普通外科研究所,210002 [2]广东医学院广东省医学分子诊断重点实验室

出　　处：《中华胃肠外科杂志》2015年第2期143-149,共7页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：系统评价加速康复外科（ERAS）理念在胰十二指肠切除围手术期应用的安全性和有效性。方法计算机检索1996年1月至2014年5月 PubMed、Embase、Medline、Web of science、Cochrane library、CNKI、万方和维普数据库有关ERAS理念在胰十二指肠切除围手术期应用的随机对照试验（RCT）或临床对照试验（CCT），由两名研究者对其进行方法学质量评价和数据提取，采用RevMan 5．2．0软件进行Meta分析。结果6项RCT和8项CCT文献纳入研究，共计2565例患者，其中ERAS组1366例，对照组（传统围手术期处理）1199例。 Meta分析结果显示：与对照组比较，ERAS组住院时间缩短（WMD＝-3．67，95％ CI：-5．66～-1．68，P＜0．05），术后并发症发生率降低（OR＝0．73，95％ CI：0．56～0．95，P＜0．05），病死率下降（OR＝0．63，95％ CI：0．44～0．91，P＜0．05），但两组再入院率和再次手术率的差异无统计学意义（均P＞0．05）。结论 ERAS理念应用于胰十二指肠切除围手术期处理具有一定的安全性和有效性。Objective To conduct a systematic review of the safety and efficacy of enhanced recovery after surgery （ERAS） program in perioperative management of pancreaticoduodenectomy. Methods A computerized search was performed in databases including PubMed, Embase, Medline, Web of Science, Cochrane Library, CNKI, Wanfang and VIP for randomized controlled trials （RCTs） or clinical controlled trials （CCTs） describing an ERAS program in patients undergoing pancreaticoduodenectomy published between January 1966 and May 2014. After assessment of methodological quality and data extraction, meta-analysis was performed using RevMan 5.2.0 software. Results Six RCTs and 8 CCTs including 2565 patients were selected for this study , including the study group （n=1366） and the control group （n=1199）. Compared with the control group, the study group had a shorter length of hospital stay （WMD=-3.67, 95% CI：-5.66--1.68, P〈0.05）, lower postoperative complication rate（OR=0.73, 95% CI：0.56-0.95, P〈0.05） and lower mortality（OR=0.63, 95% CI：0.44-0.91, P〈0.05）. However, no significant differences existed in mortality, readmission rate and re-operation rate between the two groups. Conclusions Enhanced recovery after surgery programme in perioperative management of pancreaticoduodenectomy is safe and effective. But due to the medium quality of the literature. This still need more rigorously designed RCTs to prove the safety and efficiency of ERAS programme for the patients undergoing pancreaticoduodenectomy.

关 键 词：围手术期 加速康复外科 胰十二指肠切除术 META分析 

分 类 号：R656[医药卫生—外科学]