早期肠内营养对胰十二指肠切除术后病人预后影响的Meta分析  

Effect of early enteral nutrition on prognosis of patients after pancreaticoduodenectomy,a Meta-analysis

作　　者：谈善军[1,2] 虞文魁[1] 林志亮[1] 陈启仪[1] 石佳靓[1] 董翼[1] 李宁[1] 

机构地区：[1]南京大学医学院附属金陵医院南京军区南京总医院解放军普通外科研究,江苏南京210002 [2]复旦大学附属中山医院普通外科,上海200032

出　　处：《肠外与肠内营养》2016年第1期12-17,20,共7页Parenteral & Enteral Nutrition

基　　金：全军十二五重大新上项目(AWS12J001);江苏省临床医学科技专项(BL2012006)

摘　　要：目的:系统评价早期肠内营养(EEN)和肠外营养(PN)对胰十二指肠切除术后病人预后的影响。方法:选取CNKI、万方、维普、Pub Med、EMBASE、Cochrane Library等数据库,检索1995年1月至2014年4月有关EEN和PN对胰十二指肠切除术后病人预后影响的随机对照试验(RCT)。根据纳入和剔除标准,筛选出符合标准的文献,并进行质量评价。提取相关数据后采用Revman 5.1.0软件进行Meta分析。结果:共有14项RCT纳入本次研究。在875例病人中,EEN组454例,PN组421例。经Meta分析结果显示,EEN组病人较PN组术后肠功能恢复时间明显提前,术后住院时间明显缩短,术后总并发症的发生率明显降低,住院费用明显减少。但两组之间胰瘘发生率、胃排空障碍发生率、病死率均无显著性差异(P>0.05)。结论:胰十二指肠切除术后病人早期应用EN能有效地促进术后肠功能恢复,缩短住院时间,减少术后并发症,降低住院费用。Objective：To review the effect of early enteral nutrition （EEN） versus parenteral nutrition （PN） on prognosis of patients after pancreatoduodenectomy. Methods ： The databases, inclu- ding CNKI, WanFang, VIP, PubMed, EMBASE and Cochrane Library, were searched to collect randomized controlled trials （RCT） with an objective to explore the effect of EEN versus PN on prognosis of patients after panereaticoduodenectomy between January 1995 and April 2014. The included studies were selected according to the inclusion and exclusion criteria. After quality assessment were performed, data were extracted from the included studies. This meta-analysis was conducted by using Revman 5.1.0 software. Results ：A total of 14 RCT,involving 454 patients,were included. There were 421 patients in EEN group and 267 patients in PN group. Compared with PN group, EEN group had earlier postoperative bowel func- tion recovery I WMD = - 0.61,95% CI （ - 1.12, - 0.10）, P 〈 0.05 1, shorter postoperative hospitalstay[ WMD = - 2.93,95% CI （ - 4.03, - 1.82）, P 〈 0.05 ], lower total postoperative complication rates [0R=0.57,95% CI（0.38,0.87）,P〈0.05] and hospital costs [WMD = -1.27,95% CI （ -1.81, -0.74）, P 〈 0.05 ]. However, no significant differences were found in pancreatic fistula, delayed gastric emptying and mortality （ P 〉 0.05 ）. Conclusion ： This meta-analysis shows that early enteral nutrition after pancreaticoduodenectomy could promote postoperative bowel function recovery, decreasepostoperative hospital stay and total postoperative complication as well as postoperative costs.

关 键 词：胰十二指肠切除术 早期肠内营养 META分析 

分 类 号：R656.64[医药卫生—外科学]