快速康复外科在胃癌根治术中应用疗效的系统评论

目的评价快速康复外科与传统围手术期医护方法在胃癌根治术中的临床疗效。方法计算机检索Pubmed、EMbase、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、维普中文科技期刊数据库及万方数据库。语种限于英文、中文。纳入比较快速康复外科与传统围手术期医护方法治疗胃癌根治术患者的随机或半随机对照试验,并观察两种治疗方法的术后肠道排气时间、住院天数、住院总费用及术后并发症的发生率。由两名评价员独立按纳入标准提取数据交叉核对,依据Cochrane handbook5.0.2推荐的"偏倚风险评估"工具对纳入研究进行风险偏倚评估。采用Cochrane协作网推荐软件RevMan4.2版进行统计分析。结果最终纳入10个试验,共894例。Meta分析结果显示:对于行胃癌根治术的患者中采用快速康复外科和传统围手术期治疗方法相比较,两者在术后肠道通气时间[WMD=-1.03,95%CI(-1.47,-0.60),P0.00001]、住院天数[WMD=-2.76,95%CI(-3.48,-2.03),P0.00001]、住院费用[WMD=-0.32,95%C(I-0.54,-0.10),P=0.005]方面差异均有统计学意义。而两者在术后并发症[OR=0.72,95%C(I0.48,1.07),P=0.11]的发生率方面差异无统计学意义。结论本研究结果提示,FTS在胃癌根治术患者的治疗中在术后肠道排气时间、住院天数和住院费用方面优于传统围手术期治疗方法,而术后并发症方面没有差异。术后并发症有待进一步研究。

Fast track surgery compared with conventional perioperative care in gastrectomy surgery:a systematic review of clinic randomized controlled trials

Objective To evaluate the clinic effectiveness of fast track surgery and conventional perioperative care in radical gastrectomy surgery.Methods A fully recursive literature search was conducted in PubMed,EMbase,CBM,CNKI,VIP Chinese Scientific Journals Full-text Database and Wanfang Database in English and Chinese.Randomized or quasi-randomized controlled trails of radical gastrectomy surgery treated by FTS and traditional methods were considered for inclusion.The four analyzed outcome variables were the time to passage of flatus,postoperative hospital stay,medical cost and postoperative complication rate.Data related to clinical outcomes were extracted by two reviewers independently.Statistical analyses were carried out using RevMan 4.2 software.Results Ten published reports of eligible studies involving 894 participants met the inclusion criteria.Compared with traditional methods,FTS for conventional perioperative care had significant differences in the time to passage of flatus [WMD=-1.03,95%CI(-1.47,-0.60),P <0.00001],postoperative hospital stay [WMD=-2.76,95%CI(-3.48,-2.03),P <0.00001],medical cost[WMD=-0.32,95%CI(-0.54,-0.10),P =0.005] and had no significant difference in postoperative complication rate[OR=0.72,95%CI(0.48,1.07),P =0.11].Conclusion Current evidence suggests that FTS is superior to traditional methods for radical gastrectomy surgery in the time to passage of flatus,postoperative hospital stay and medical cost.There is no significant difference in postoperative complication rate between the two methods.More studies are needed for postoperative complication rate.