加速康复外科对消化道肿瘤患者长期生存率影响的Meta分析  

Impact of enhanced recovery after surgery programs on long-term survival among patients undergoing digestive tract tumor surgery:A meta-analysis

作　　者：冀海斌 陈强谱[1] 张帆[1] 朱文涛[1] 赵宝磊[1] 魏强[1] 孙宝房 杨祯 王霄霄 Hai-Bin Ji;Qiang-PuChen;Fan Zhang;Wen-Tao Zhu;Bao-Lei Zhao;Qiang Wei;Bao-Fang Sun;Zhen Yang;Xiao-Xiao Wang(Department of Hepatobiliary Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong Province,China)

机构地区：[1]滨州医学院附属医院肝胆外科,山东省滨州市256603

出　　处：《世界华人消化杂志》2019年第7期442-449,共8页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81502069;山东省普外科临床重点专科建设基金;No.ZDZK2013SJ09;山东省自然科学基金资助项目;No.BS2015YY025~~

摘　　要：背景加速康复外科(enhanced recovery after surgery, ERAS)是指在围手术期通过多学科协作模式采取一系列基于循证医学证据的最优化措施,降低围手术期应激反应,加快患者术后各器官功能恢复. ERAS已在多个学科得到推广,并被证实可以提高患者近期预后,而针对患者远期预后的研究正在初步进行.目的评价围手术期应用ERAS对消化道肿瘤患者生存率的影响.方法应用计算机检索1995-01/2018-11万方、CNKI、维普、PubMed、Cochrane Library、EMBASE数据库有关消化道肿瘤患者围手术期应用ERAS的随机对照试验、病例对照研究,由两名研究者分别对符合纳入标准的研究进行质量评价和数据提取,采用Rev Man5.3.5软件进行Meta分析.结果共纳入10篇研究进行Meta分析,共计2477例患者,其中ERAS组751例,对照组(采取传统围手术期管理)1726例.与对照组相比, ERAS组术后3年生存率提高(OR=0.48, 95%CI:0.30-0.78, P<0.05),术后5年生存率提高(OR=0.51, 95%CI:0.40-0.65, P<0.05);两组术后1年生存率差异无统计学意义(OR=1.13, 95%CI:0.63-2.02, P>0.05),术后2年生存率差异无统计学意义(OR=1.19, 95%CI:0.38-3.73, P>0.05).结论消化道肿瘤手术围手术期实施ERAS可以改善预后,3年生存率, 5年生存率.BACKGROUND Enhanced recovery after surgery (ERAS) programs refer to a series of optimization measures based on evidencebased medical evidence to reduce perioperative stress response and speed up the recovery of organ function after surgery through a multi-disciplinary collaboration model. ERAS has been popularized in many disciplines and proved to improve the short-term prognosis of patients, while the study of long-term prognosis of patients is limited. AIM To evaluate the impact of ERAS programs on the longterm survival among patients undergoing digestive tract tumor surgery. METHODS Computer searches were performed in databases including Wanfang, CNKI, VIP, PubMed, Cochrane Library, and Embase for randomized controlled trials or case-control studies describing ERAS programs in patients undergoing digestive tract tumor surgery published between January 1995 and November 2018. Two researchers independently evaluated the quality of studies that met the inclusion criteria and performed a meta-analysis using RevMan5.3.5 software. RESULTS A total of ten studies including 2477 patients were selected for the meta-analysis, including the ERAS group (n = 751) and the control group (n = 1726, undergoing traditional perioperative management). Compared with the control group, the ERAS group had improved 3-year survival (OR = 0.48, 95%CI: 0.30-0.78, P < 0.05) and 5-year survival (OR = 0.51, 95%CI: 0.40-0.65, P < 0.05). However, no significant difference was observed in 1-year survival (OR = 1.13, 95%CI: 0.63-2.02, P > 0.05) or 2-year survival (OR = 1.19, 95%CI: 0.38-3.73, P > 0.05) between the two groups. CONCLUSION Perioperative implementation of ERAS programs can improve outcomes and 3- and 5-year survival among patients undergoing digestive tract tumor surgery.

关 键 词：加速康复外科 生存率 肿瘤预后 META分析 

分 类 号：R735[医药卫生—肿瘤]