加速康复外科应用于小儿先天性胆总管囊肿围手术期的Meta分析  

Application of enhanced recovery after surgery for congenital choledochal cyst in children:a meta-analysis

作　　者：郭志恒 苏璠 丁道奎[3] 岳铭[3] 张国锋[3] 李延安[3] 孙贝贝[3] 杨合英[3] Guo Zhiheng;Su Fan;Ding Daokui;Yue Ming;Zhang Guofeng;Li Yan'an;Sun Beibei;Yang Heying(Department of General Surgery,Huaihe Hospital of Henan University,Kaifeng 475000,China;Department of Critical Care Medicine,Henan Children's Hospital,Zhengzhou 450018,China;Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]河南大学淮河医院普外科,开封475000 [2]河南省儿童医院重症医学科,郑州450018 [3]郑州大学第一附属医院小儿外科,郑州450052

出　　处：《中华小儿外科杂志》2023年第12期1091-1097,共7页Chinese Journal of Pediatric Surgery

基　　金：河南省医学科技攻关省部共建重点项目(SBGJ202102114)。

摘　　要：目的系统评价加速康复外科(enhanced recovery after surgery,ERAS)理念在小儿胆总管囊肿围手术期应用的安全性及可行性。方法在万方医学网、中国知网、PubMed、Web of Science以及EBSCO等中英文数据库中检索关于ERAS应用于小儿先天性胆总管囊肿的文献,仅检索中英文文献,起止时间为2000年1月1日至2021年8月31日。中文关键词为:快速康复外科、加速康复外科、胆总管囊肿、胆管扩张症和手术;英文关键词为:enhanced recovery after surgery、fast track surgery、ERAS、FTS、choledochal cysts、choledochocyst、bile duct cyst、biliary dilatations、surgery。选择2名研究人员完成数据录入,包括病例数、围手术期处理措施、术后首次排气排便时间、术后住院时间和并发症发生情况。采用Stata 13.0进行Meta分析,研究间异质性检验采用I2检验,根据检验结果采用固定效应模型或随机效应模型,采用Begg’’s检测评估发表偏倚,对术后首次排气排便时间和术后住院时间进行敏感性分析。结果最终纳入7篇有关ERAS理念应用于小儿先天性胆总管囊肿围手术期的研究,共计478例患儿。ERAS组术后首次排气排便时间较传统组明显缩短(SMD=1.19,95%CI:0.86~1.52,P<0.001)、术后住院时间也明显缩短(SMD=1.97,95%CI:1.55~2.38,P<0.001);并发症方面,与传统组相比,ERAS组在术后切口感染的发生率(OR=0.32,95%CI:0.10~0.98,P<0.05)、术后吻合口瘘的发生率(OR=0.16,95%CI:0.03~0.91,P<0.05)和术后呼吸道感染的发生率(OR=0.19,95%CI:0.06~0.60,P<0.05)均有所降低。结论ERAS理念应用于小儿胆总管囊肿围手术期可加速患儿术后肠功能恢复、缩短术后住院时间,同时降低术后并发症的发生,是安全有效的。Objective To systematically review the safety and feasibility of perioperative application of enhanced recovery after surgery(ERAS)for children with congenital choledochal cyst.Methods The literatures about the application of ERAS in pediatric congenital choledochal cyst were searched in Chinese and English databases including Wanfang Medical Network,CNKI,PubMed,Web of Science and EBSCO.Only Chinese and English literatures were searched from January 1,2000 to August 31,2021.English and Chinese keywords included enhanced recovery after surgery,fast track surgery,ERAS,FTS,choledochal cysts,choledochocyst,bile duct cyst,biliary dilatation and surgery.Two researchers were selected to complete data entry,including case load,perioperative interventional measures,initial postoperative exhaust and defecation time,postoperative length of stay and complications.Meta-analysis was performed with Stata 13.0 software.And I2 test was utilized for examining the heterogeneity between the eligible studies.And fixed/random-effect model was employed according to the test results.Publication bias was assessed by Begg's test.Sensitivity analysis was performed for initial postoperative defecation time and postoperative hospitalization stay.Results Seven articles with a total of 478 cases were retrieved.As compared with conventional group,ERAS group had significantly shorter initial postoperative defecation(SMD=1.19,95%CI:0.86-1.52,P<0.001)and postoperative length of hospitalization stay(SMD=1.97,95%CI:1.55-2.38,P<0.001).ERAS group had a lower incidence of postoperative incision infection(OR=0.32,95%CI:0.10-0.98,P<0.05),postoperative anastomotic leakage(OR=0.16,95%CI:0.03-0.91,P<0.05)and postoperative respiratory tract infection(OR=0.19,95%CI:0.06-0.60,P<0.05).Conclusions For children with choledochal cyst,application of ERAS concept in perioperative period is both safe and feasible.It may accelerate the recovery of postoperative intestinal function,shorten postoperative length of stay and lower the occurrence of postoperative complicat

关 键 词：胆总管囊肿 先天性 加速康复外科 儿童 荟萃分析 

分 类 号：R726.5[医药卫生—儿科]