加速康复外科模式在胰体尾切除术中安全性和有效性的荟萃分析  

Meta-analysis on the safety and efficacy of the enhanced recovery after surgery in distal pancreatectomy

作　　者：杨峻峰 杜丽文 叶舰 刘建生[1] Yang Junfeng;Du Liwen;Ye Jian;Liu Jiansheng(Department of Hepatobiliary Pancreatic Surgery&Liver Transplant Center,The First Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学第一医院肝胆胰外科及肝脏移植中心,太原030000

出　　处：《中华胰腺病杂志》2023年第3期199-206,共8页Chinese Journal of Pancreatology

摘　　要：目的荟萃分析加速康复外科(ERAS)的治疗模式对于胰体尾切除术的安全性和有效性。方法以胰体尾切除术、远端胰腺切除术、加速康复外科、快速康复外科、pancreatectomy、distal pancreatectomy、enhanced recovery after surgery(ERAS)为检索词,检索中国知网、万方、维普、中国生物医学文献、Pubmed、Embase、CochraneLibrary、Web of Science、Sciencedirect等数据库,检索时限从建库至2022年5月。搜索关于ERAS和胰体尾切除术的可回顾性分析研究,按照预先设定的纳人和排除标准筛选文献及评估文献质量并提取数据。采用软件ReviewManager5.4进行荟萃分析。结果最终纳人9篇文献,共650例胰体尾切除患者,其中ERAS组311例,NO-ERAS组339例。荟萃分析结果显示,胰体尾切除的患者行ERAS治疗相较于NO-ERAS组,能够减少术中出血(MD=-73.88,95%CI-121.21~-26.55,P=0.002),降低术后并发症发生率(0R=0.48,95%CI0.32~0.72,P<0.001)及肺部感染发生率(0R=0.47,95%CI0.24~0.93,P=0.030),减短术后首次排气时间(MD=-8.76,95%CI-11.23~-6.29,P<0.001)、术后住院时间(MD=-2.65,95%CI-3.06~-2.07,P<0.001)及腹腔引流管拔除时间(MD=-1.45,95%CI-1.81~-1.09,P<0.001);而不能缩短胰体尾切除患者的手术时间(MD=6.25,95%CI-4.56~17.07,P=0.260),不能降低术后胰瘘的发生率(0R=0.92,95%CI0.53~1.60,P=0.780)及术后30d内再入院率(0R=1.00,95%CI0.47~2.11,P=0.990)。结论ERAS治疗模式对于胰体尾切除术患者是安全有效的,能够减少患者的术中出血,降低患者术后并发症的发生,缩短患者术后住院时间及腹腔引流管拔除时间。Objective The safety and effectiveness of the enhanced recovery after surgery(ERAS)in the treatment of distal pancreatectomy(DP)were evaluated by meta-analysis.Methods Pancreatic body and tail resection,distal pancreatic resection,ERAS,rapid recovery after surgery,pancreatectomy,DP and ERAS were used as key words,and the network database such as Chinese journal full-text database,Wanfang data knowledge service platform,Weipu database,Chinese biomedical literature database,Pubmed,Embase,Cochrane library,Web of science,Sciencedirect and so on were searched.The retrospective literatures published from the database establishment to May 2022 were retrieved from the network database,and the papers were screened and the quality was evaluated according to the pre-set inclusion and exclusion criteria;and important data were extracted.The software Review Manager 5.4 was used for meta-analysis.Results 9 papers were finally included,and a total of 650 patients with DP were enrolled(311 in the ERAS group and 339 in the NO-ERAS group).Meta-anaysis showed that compared with NO-ERAS group,ERAS group could reduce intraoperative bleeding(MD=-73.88,95%CI-121.21--26.55,P=0.002),decrease the incidence of postoperative complications(OR=0.48,95%CI 0.32-0.72,P<0.001)and pulmonary complications(OR=0.47,95%CI 0.24-0.93,P=0.030),shorten the postoperative exhaust time(MD=-8.76,95%CI-11.23--6.29,P<0.001),postoperative length of hospital stay(MD=-2.65,95%CI-3.06--2.07,P<0.001)and abdominal drainage tube removal time(MD=-1.45,95%CI-1.81--1.09,P<0.001).However,ERAS could not shorten the operative time(MD=6.25,95%CI-4.56-17.07,P=0.260),reduce the incidence of postoperative pancreatic fistula(OR=0.92,95%CI 0.53--1.60,P=0.780)and the re-admission rate within 30 days after surgery(0R=1.00,95%CI 0.47-2.11,P=0.990).Conclusions ERAS is safe and effective for patients undergoing DP,because it can reduce intraoperative bleeding and postoperative complications,shorten postoperative hospital stay and postoperative abdominal drainage tube removal time.

关 键 词：胰体尾切除术 加速康复外科 荟萃分析 

分 类 号：R657.5[医药卫生—外科学]