围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析  

Meta-analysis of efficacy and safety of perioperative enteral nutrition in patients with primary liver cancer undergoing hepatectomy

作　　者：龚财芳 赵俊宇 游川[1] Gong Caifang;Zhao Junyu;You Chuan(Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Graduate School of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院肝胆外科,四川省南充市637000 [2]川北医学院研究生院,四川省南充市637000

出　　处：《中华肝脏外科手术学电子杂志》2024年第4期551-556,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：南充市市校合作项目(19SXHZ0392);川北医学院附属医院2023年度第二批科研发展计划(2022MPRW001)

摘　　要：目的系统评价围手术期肠内营养(EN)在原发性肝癌(肝癌)肝切除术患者中的有效性及安全性。方法检索建库至2022年6月在中国生物医学文献服务系统(CBM)、万方、知网(CNKI)、维普(VIP)、PubMed、Cochrane Library、Web of Science、Embase数据库中发表的关于肝癌肝切除患者围手术期EN的研究。中文检索词:肝切除术、肝脏切除、肝部分切除、肝癌、肝肿瘤、围手术期营养、术前营养、术后营养。英文检索词:hepatectomy、liver resection、partial hepatectomy、liver neoplasms、perioperative nutrition、enteral feeding、postoperative nutrition。主要结局指标为术后ALB、肝功能、胃肠功能恢复等指标。采用RevMan 5.4软件进行Meta分析。结果最终纳入16篇RCT文献,共1390例患者。Meta分析显示,与常规营养或静脉营养支持相比,围手术期EN在提高术后ALB(MD=2.22,95%CI:0.96~3.49,P<0.05),降低ALT(MD=-9.45,95%CI:-17.71~-1.20,P<0.05)和TB水平(MD=-3.92,95%CI:-5.37~-2.11,P<0.05),缩短患者术后首次排气时间(SMD=-1.42,95%CI:-1.95~-0.90,P<0.05)、排便时间(SMD=-1.46,95%CI:-2.12~-0.81,P<0.05)、术后住院时间(MD=-2.28,95%CI:-3.04~-1.52,P<0.05),降低术后胃肠道不适发生率(OR=0.35,95%CI:0.22~0.57,P<0.01)等方面差异有统计学意义。结论与常规营养相比,围手术期EN可改善肝癌患者营养状况,促进术后肝功能及胃肠功能恢复,降低术后胃肠道不良反应发生率,缩短术后住院时间,促进患者术后康复。Objective To systematically evaluate the efficacy and safety of perioperative enteral nutrition(EN)in patients with primary liver cancer(PLC)undergoing hepatectomy.Methods Studies related to perioperative EN in PLC patients undergoing hepatectomy were retrieved from China Biomedical Literature Service System(CBM),Wanfang Data,CNKI,Chongqing VIP,PubMed,Cochrane Library,Web of Science and Embase databases from the database inception to June 2022.The searching words included hepatectomy,liver resection,partial hepatectomy,liver neoplasms,perioperative nutrition,enteral feeding and postoperative nutrition in both Chinese and English.The main outcome indexes were postoperative ALB,liver function and gastrointestinal function recovery,etc.Meta-analysis was carried out by RevMan 5.4 software.Results 16 RCTs consisting of 1390 patients were finally included.Meta-analysis showed that compared with routine nutrition or intravenous nutrition support,perioperative EN increased postoperative ALB level(MD=2.22,95%CI:0.96-3.49,P<0.05)and decreased ALT level(MD=-9.45,95%CI:-17.71--1.20,P<0.05)and TB level(MD=-3.92,95%CI:-5.37--2.11,P<0.05),shorten the first postoperative exhaust time(SMD=-1.42,95%CI:-1.95--0.90,P<0.05),the defecation time(SMD=-1.46,95%CI:-2.12--0.81,P<0.05)and the length of postoperative hospital stay(MD=-2.28,95%CI:-3.04--1.52,P<0.05),and reduce the incidence of postoperative gastrointestinal discomfort(OR=0.35,95%CI:0.22-0.57,P<0.05).Conclusions Compared with routine nutrition,perioperative EN can improve the nutritional status,promote the recovery of postoperative liver and gastrointestinal function,reduce the incidence of postoperative gastrointestinal adverse reactions,shorten the length of postoperative hospital stay and accelerate postoperative rehabilitation of PLC patients.

关 键 词：肠内营养 营养支持 癌 肝细胞 肝切除术 META分析 

分 类 号：R735.7[医药卫生—肿瘤]