快速康复外科方案应用于肝脏手术的meta分析  

The therapeutic effect of hepatectomy with fast track programs:a meta-analysis

作　　者：于志远 孙岩[1] 张旭[1] 陈晓宁[1] 孙世波[1] YU Zhi-yuan;SUN Yan;ZHANG Xu(Department of General Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院普外七科,黑龙江哈尔滨150086

出　　处：《腹腔镜外科杂志》2020年第9期673-682,共10页Journal of Laparoscopic Surgery

摘　　要：目的:系统评价快速康复外科(FT)与传统围手术期方案应用于肝切除术中的临床效果。方法:计算机检索PubMed、The Cochrane Library、Embase、万方、CNKI数据库,搜集对比FT与传统围手术期方案应用于肝切除术的随机对照研究(RCT)、队列研究与病例-对照研究,检索时限为自数据库建库至2019年12月。由两位作者分别进行质量评估并提取数据资料,结局指标包括手术时间、术中出血量、住院时间、术后相关并发症、再入院率及死亡率、住院费用等情况,将最终纳入的文献数据整理后进行Meta分析。结果:共纳入6篇RCT、8篇非RCT研究,其中FT组1024例,传统组1008例。meta分析结果显示,与传统肝脏手术围手术期方案相比,FT组患者术后住院时间更短[MD=-2.02,95%CI(-2.78,-1.26),P<0.00001]、术中出血量更少[SMD=-0.19,95%CI(-0.34,-0.04),P=0.01]、术后总并发症[OR=0.51,95%CI(0.40,0.64),P<0.00001]与GradeⅡ~Ⅳ级并发症[OR=0.47,95%CI(0.32,0.69),P=0.003]发生率更低、住院费用[SMD=-0.81,95%CI(-1.09,-0.53),P<0.00001]更少;两组手术时间[SMD=-0.03,95%CI(-0.16,0.09),P=0.62]、再入院率[OR=0.78,95%CI(0.51,1.19),P=0.25]及死亡率[OR=0.79,95%CI(0.15,4.10),P=0.78]差异无统计学意义。结论:与传统围手术期临床策略相比,肝脏手术中应用FT方案可促进术后恢复,减少并发症的发生,缩短住院时间,节省住院费用,可在临床上进一步推广应用,有望成为肝脏手术围手术期处理的标准措施。Objective:To systematically evaluate the clinical effect of two perioperative methods which contain fast track(FT)programs and traditional care(TC)in liver surgery.Methods:PubMed,The Cochrane Library,Embase,WanFang Data and CNKI databases were electronically searched to collect randomized controlled studies(RCT),cohort studies and case-control studies on the efficacy and safety of FT perioperative regimen versus TC perioperative regimen in liver surgery from creation of database to Dec.2019.Two authors conducted quality assessment and extracted data respectively.The outcome indicators included operative time,intraoperative blood loss,hospital stay,postoperative complications,readmission rate,mortality and hospitalization costs.At last,the final included literature data for meta-analysis was sorted out.Results:A total of fourteen clinical studies were included in the analysis,which contained six RCT studies and eight non-RCT studies,with 1024 cases in the FT group and 1008 cases in the TC group.The results of meta-analysis showed that FT could reduce postoperative hospital stay[MD=-2.02,95%CI(-2.78,-1.26),P<0.00001],intraoperative blood loss[SMD=-0.19,95%CI(-0.34,-0.04),P=0.01],total postoperative complications[OR=0.51,95%CI(0.40,0.64),P<0.00001]and GradeⅡ~Ⅳcomplications[OR=0.47,95%CI(0.32,0.69),P=0.003],and hospitalization cost[SMD=-0.81,95%CI(-1.09,-0.53),P<0.00001],without increasing operating time[SMD=-0.03,95%CI(-0.16,0.09),P=0.62],readmission rate[OR=0.78,95%CI(0.51,1.19),P=0.25],or mortality[OR=0.79,95%CI(0.15,4.10),P=0.78].Conclusions:Compared with the traditional perioperative strategy,the application of FT in liver surgery can promote postoperative recovery and reduce surgical complications,hospital stay and costs.It can be further popularized and applied in clinical practice and is expected to become the standard measure of perioperative management of liver surgery.

关 键 词：快速康复外科 肝切除术 META分析 

分 类 号：R657.3[医药卫生—外科学]