加速康复外科理念在全胸腹腔镜联合食管癌根治术中应用的安全性与有效性:一项Meta分析  

Meta-analysis of the safety and efficacy of the application of enhanced recovery after surgery concept in totally thoracoscopic-laparoscopic esophageal cancer radical surgery

作　　者：杨柳 张修华 邢加强 YANG Liu;ZHANG Xiuhua;XING Jiaqiang(Special Inspection Department,Linyi Cancer Hospital,Linyi 276000,China;Department of Thoracic Surgery,Linyi Cancer Hospital)

机构地区：[1]临沂市肿瘤医院特检科,山东临沂276000 [2]临沂市肿瘤医院胸外科

出　　处：《腹腔镜外科杂志》2025年第1期61-69,共9页Journal of Laparoscopic Surgery

摘　　要：目的:系统评价加速康复外科(ERAS)理念在全胸腹腔镜联合食管癌根治术(TLE)中应用的安全性与有效性。方法:计算机检索从建库至2024年2月国内外数据库有关ERAS在TLE中应用的文献资料。对纳入文献采用RevMan 5.3软件进行Meta分析。结果:共纳入16篇文献、2036例患者,其中ERAS组1048例,常规组988例。Meta分析结果显示,与常规组相比,ERAS组首次下床时间更早(MD=-1.45,95%CI=-2.24~-0.66,P=0.0003),肛门排气时间更早(MD=-0.81,95%CI=-1.02~-0.60,P<0.00001),胸腔引流管拔除时间更短(MD=-3.17,95%CI=-4.92~-1.41,P=0.0004),住院时间更短(MD=-3.45,95%CI=-4.39~-2.52,P<0.00001),住院费用更低(MD=-0.73,95%CI=-1.01~-0.44,P<0.00001),术后总并发症发生率更低(OR=0.42,95%CI=0.27~0.65,P=0.0001)。结论:TLE围手术期应用ERAS是安全、有效的,可促进患者快速康复。Objective:To evaluate the safety and efficacy of the enhanced recovery after surgery(ERAS)concept in totally thoracoscopic-laparoscopic esophageal cancer radical surgery(TLE)using a systematic meta-analysis approach.Methods:The literature data on the application of ERAS in TLE from domestic and foreign databases were retrieved by computer from the inception of the database to Feb.2024.Meta-analysis was performed on the included studies using RevMan 5.3 software.Results:A total of 16 articles were included,with a total of 2036 patients,including 1048 in the ERAS group and 998 in the conventional group.The meta-analysis r esults showed that compared with the conventional group,the ERAS group had a earlier ambulation time(MD=-1.45,95%CI=-2.24~-0.66,P=0.0003),earlier time to first flatus(MD=-0.81,95%CI=-1.02~-0.60,P<0.00001),shorter time to thoracic drainage tube removal(MD=-3.17,95%CI=-4.92~-1.41,P=0.0004),shorter hospital stay(MD=-3.45,95%CI=-4.39~-2.52,P<0.00001),and lower hospitalization costs(MD=-0.73,95%CI=-1.01~-0.44,P<0.00001),lower overall postoperative complication rate(OR=0.42,95%CI=0.27~0.65,P=0.0001).Conclusions:The application of ERAS in the perioperative period of TLE is safe and effective,and can promote rapid patient recovery.

关 键 词：食管肿瘤 食管癌根治术 胸腔镜检查 腹腔镜检查 术后加速康复 META分析 

分 类 号：R735.1[医药卫生—肿瘤]