早期肠内营养和肠外营养对食管癌术后患者临床疗效的Meta分析

目的应用Meta分析法比较食管癌术后患者早期给予肠内营养(EN)和肠外营养(PN)的临床疗效。 方法通过计算机数据库检索PubMed、Embase、The Cochrane Library数据库，人工查找有关食管癌术后患者EN和PN支持治疗的随机对照试验，检索时限截至2018年1月。由两位作者按纳入、排除标准独立地筛选文献、提取资料和评价偏倚风险，再采用R软件的Meta包进行分析。 结果最终纳入15个随机对照试验，包括1 400例患者，其中EN组707例，PN组693例。Meta分析显示：与PN相比，EN能提高食管癌患者术后白蛋白(RBP)水平(平均值为2.11 g/L，95% CI：1.30～2.93，P<0.001)和视黄醇结合蛋白质水平(平均值为1.57 mg/L，95% CI：0.32～2.82, P<0.01)，降低术后肺部感染发生率(RR＝0.40，95% CI：0.27～0.61，P<0.001)和切口感染发生率(RR＝0.38，95% CI：0.16～0.88，P＝0.024)；但两组间术后前清白蛋白水平(平均值1.12 g/L，95% CI：－0.04～2.27，P＝0.058)、吻合口漏发生率(RR＝0.70，95% CI：0.43～1.13，P＝0.141)、总并发症发生率(RR＝0.84，95% CI：0.70～1.01，P＝0.061)比较差异无统计学意义。 结论食管癌术后早期给予EN，可以提高患者的营养状况，降低肺部感染和切口感染的发生率，但在吻合口漏的发生率上与PN相比无明显差别。

Meta analysis of early enteral nutrition and parenteral nutrition for postoperative patients with esophageal cancer

ObjectiveMeta-analysis was used to compare the clinical efficacy of early enteral nutrition and parenteral nutrition in patients with esophageal cancer. MethodsThe PubMed, Embase, and the Cochrane Library databases were used to search for randomized controlled trials of enteral nutrition and parenteral nutrition for postoperative patients with esophageal cancer. The search time was up to January 2018. Two authors independently screened the literature, extracted the data, assessed the risk of bias, and analyzed them using the Meta package of R (a data analysis software). ResultsA total of 15 randomized controlled trials were selected, including 1 400 patients with 707 in the enteral nutrition group and 693 in the parenteral nutrition group. Meta-analysis showed that enteral nutrition improved postoperative protein levels (MD=2.11 g/L, 95% CI: 1.30-2.93, P < 0.001) and retinol-binding protein(RBP) level (MD=1.57 mg/L, 95% CI: 0.32-2.82, P < 0.01), reduced the incidence of postoperative pulmonary infection (RR = 0.40, 95% CI: 0.27-0.61, P < 0.001) and the incidence of wound infection (RR=0.38, 95% CI: 0.16-0.88, P=0.024) compared to parenteral nutrition group. There were no significant difference between the two groups in postoperative serum albumin level (MD = 1.12 g/L, 95% CI: -0.04-2.27, P=0.058 ) , the incidence of anastomotic leakage(RR=0.70, 95% CI: 0.43-1.13, P=0.141)and overall complication rate (RR = 0.84, 95% CI: 0.70-1.01, P = 0.061). ConclusionsEarly postoperative enteral nutrition can improve the nutritional status and reduce the incidence of pulmonary infection and wound infection; but there is no significant difference in the incidence of anastomotic leakage between the two methods.