快速康复外科理念在胆总管切开取石术围手术期应用疗效的Meta分析  

Application efficacy of fast track surgery concept in perioperative period of choledocholithotomy:a Meta-analysis

作　　者：廖启成 谢星 王小农[1] 何晓[1] 李红春[3] 

机构地区：[1]赣南医学院第一附属医院肝胆外科,江西省赣州市341000 [2]赣南医学院 [3]深圳市第三人民医院肝胆疾病研究重点实验室,518100

出　　处：《中华肝脏外科手术学电子杂志》2017年第5期378-383,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：深圳市肝胆疾病研究重点实验室项目(ZDSYS201504301534057);赣南医学院科技创新项目(YC2016-X010)

摘　　要：目的探讨快速康复外科(FTS)理念在胆总管切开取石术围手术期应用的疗效。方法计算机检索2016年2月之前Pubmed、Cochrane Library数据库、万方数据库、维普数据库和中国知网(CNKI)公开发表的关于FTS理念在胆总管切开取石术围手术期中应用的相关文献。检索词:快速康复、加速康复、快通道外科、胆总管结石、胆总管探查、胆道手术、胆道外科、fast track surgery、FTS、enhanced recovery after surgery、ERAS等。FTS组为胆总管切开取石术围手术期采用FTS方法处理,对照组为围手术期采用传统方法处理。比较两组术后并发症发生率、首次肛门排气时间、住院费用和术后住院时间。采用固定效应模型或随机效应模型进行Meta分析。结果共有10篇文献纳入研究,病例数1 204例。其中FTS组627例,对照组577例。Meta分析结果显示,与对照组相比,FTS组术后总并发症发生率明显降低[RR=0.49,95%CI(0.39,0.60),P<0.05];首次肛门排气时间明显缩短[SMD=-1.65,95%CI(-2.14,-1.17),P<0.05];住院费用明显降低[SMD=-1.08,95%CI(-1.28,-0.88),P<0.05];术后住院时间明显缩短[WMD=-2.94,95%CI(-3.24,-2.63),P<0.05]。各项研究中均无死亡病例。结论 FTS理念应用于胆总管切开取石术围手术期可明显降低术后并发症发生率和住院费用,加速患者术后康复。Objective To investigate the application efficacy of fast track surgery （FTS） concept in the perioperative period of choledocholithotomy. Methods Relevant literatures about the application of FTS concept in the perioperative period of choledocholithotomy published before February 2016 were searched from PubMed, Cochrane Library database, Wanfang database, Chongqing Vip database and CNKI by computer. The searching keywords included fast recovery, accelerated recovery, fast track surgery, FTS, enhanced recovery after surgery, ERAS, common bile duct stone, exploration of common bile duct, biliary tract operation, billiary tract surgery, etc. FTS method was used in the perioperative period of choledocholithotomy in the FTS group, while conventional method was used in the control group, The incidence of postoperative complications, the first anal exhaust time, hospitalization expense and postoperative length of hospital stay were compared between two groups. Fixed or random effect model was utilized for Meta-analysis. Results A total of 10 literatures, consisting of 1 204 cases, 627 in the FTS group and 577 in the control group, were included in this study. Meta-analysis revealed that compared with the control group, the incidence of total postoperative complications in the FTS group was significantly decreased [RR=0.49, 95%CI （0.39, 0.60）, P〈0.05], the first anal exhaust time was significantly shorter [SMD= - 1.65, 95%CI（-2.14, - 1.17）, P〈0.05], the hospitalization expense was significantly reduced [SMD=- 1.08, 95%CI （-1.28, -0.88）, P〈0.05）], and the postoperative length of hospital stay was significantly shorter [WMD =-2.94, 95%CI （-3.24, -2.63）, P〈0.05]. No patient died in either group. Conclusions Application of FTS concept in the perioperative period of choledocholithotomy can significantly reduce the incidence of postoperative complications and hospitalization expense, accelerate the postoperative recovery of the patients.

关 键 词：快速康复外科 胆总管结石 META分析 手术后并发症 疗效比较研究 

分 类 号：R657.42[医药卫生—外科学]