早期经口进食对食管癌病人术后并发症和康复疗效影响的Meta分析

目的:探讨早期经口进食(early oral feeding, EOF)与延迟经口进食(late oral feeding, LOF)对食管癌术后病人的可行性与安全性。方法:通过计算机检索PubMed、Medline、Embase、The Cochrane Library、Web of Science、万方、中国知网、维普、中国生物医学文献数据库,查找关于EOF与LOF食管癌术后病人的随机对照试验(randomized controlled trial, RCT),检索时限为数据库建库至2021年10月。2名研究员按照纳入与排除标准对文献进行筛选,质量评价与资料提取后采用RevMan 5.3软件进行Meta分析。结果:最终纳入6篇文献,共713例病人。Meta分析结果显示,食管癌病人术后EOF可明显缩短术后首次排气时间[MD=-1.58,95%CI(-2.30,-0.85),P<0.000 1]、排便时间[MD=-1.75,95%CI(-2.62,-0.87),P<0.000 1]和术后住院时间[MD=-2.99,95%CI(-3.07,-2.90),P<0.000 ...     

术后早期经口进食对食管癌患者预后影响的meta分析

目的 采用meta分析评估术后早期经口进食对食管癌患者的影响,评价其安全性和有效性。方法 计算机检索PubMed、Web of Science、Cochrane Library、 EMBSCO、中国知网、万方数据库以及维普数据库建库至2022年6月发表的关于食管癌术后患者早期经口进食的干预性研究。由2名评价人员按照纳排标准独立筛选文献、提取资料、评价文献质量。采用RevMan 5.3软件对提取资料进行Meta分析。结果 共纳入6篇文献,涉及到1306例食管切除术后患者。Meta分析结果显示食管癌切除患者术后早期经口进食组较传统进食组术后首次排气时间（MD=－1.11,95%CI（－1.25,－0.96）,P＜0.00001）、术后首次排便时间（MD=－1.68,95%CI（－2.13,－1.22）,P＜0.00001）、术后肺部并发症发生率（RR=0.76,95%CI（0.58,0.99）,P=0.04）、术后住院时间（MD=－3.40,95%CI（－5.30,－1.49）,P=0.0005）、术后生活质量（MD=4.77,95%CI（2.27,7.26）,P=0.0002）,差异具有统计学意义;术后吻合口瘘发生率（RR=0.88,95%CI（0.55,1.41）,P=0.59）、术后乳糜胸发生率（RR=0.72,95%CI（0.22,2.38）,P=0.59）,差异不具有统计学差异。结论 meta分析结果基本稳定可靠,食管癌术后早期经口进食有助于促进胃肠功能早期恢复、减少术后肺部并发症发生率、不增加术后吻合口瘘和乳糜胸等并发症发生率,具有安全性和有效性。     

急性非静脉曲张性上消化道出血患者早期经口进食效果的Meta分析

目的 系统评价急性非静脉曲张性上消化道出血（acute non-variceal upper gastrointestinal bleeding,ANVUGIB）患者止血后24 h内早期经口进食的安全性及有效性,为临床实践提供参考依据。方法 计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Web of Science、Embase、Cochrane Library、CINAHL中关于ANVUGIB患者早期经口进食的随机对照试验和队列研究,检索时限为建库至2022年9月。由2名研究者对文献进行筛选、资料提取及方法 学质量评价,并应用RevMan 5.4和Stata 13.0软件进行统计分析。结果 共纳入4篇随机对照试验和1篇队列研究,文献质量评价结果 均为B级。共纳入803例患者,其中试验组（早期经口进食）384例,对照组（常规禁食）419例。Meta分析结果 示,两组再出血率[RR=0.87,95%CI(0.47,1.64),P=0.670]、病死率[RR=0.46,95%CI(0.19,1.08),P=0.080]、住院费用[SMD=-1.50,95...     

剖宫产术后早期进食对胃肠道功能恢复影响随机对照试验的 Meta分析

目的：探讨剖宫产术后早期进食与胃肠道功能恢复的相关性。方法计算机检索PubMed、Ovid、维普、CNKI、万方等数据库中关于剖宫产术后早期进食与胃肠道功能相关性的随机对照试验进行Meta分析。结果剖宫产早期进食组肠鸣音恢复时间有提前趋势,WMD＝－10．17,95％CI＝－15．35,－4．99,Z＝3．85,P＜0．0001;肛门排气时间有提前趋势,WMD＝－10．52,95％CI＝－13．00,－8．03,Z＝8．30,P＜0．00001;解便时间有提前趋势,WMD＝－26．79,95％CI＝－41．72,－11．85,Z＝3．52,P＝0．0004,早期进食组发生腹胀风险较对照组少,RR＝0．72,95％CI＝0．57～0．92,Z＝2．59,P＝0．010。结论剖宫产术后早期进食可以缩短胃肠功能恢复时间,减少腹胀发生。     

基于循证构建轻症急性胰腺炎患者早期经口进食时机评估及管理方案

目的基于循证方法构建轻症急性胰腺炎患者经口进食时机评估及管理方案。方法主题词检索中外数据库,获取与轻症急性胰腺炎经口进食时机相关文献,进行文献质量评价及证据等级划分,采用小组讨论方法制定急性胰腺炎患者经口进食时机评估及管理草案,通过2轮消化内科专家函询对草案进行修订。结果形成轻症急性胰腺炎患者早期经口进食时机评估及管理方案,包括一级指标2项,二级指标8项,三级指标29项;2轮函询专家权威系数分别为0.930、0.934;专家协调系数0.083、0.142。结论基于循证方法的轻症急性胰腺炎患者经口进食时机评估及管理方案专家积极性及权威性高、意见协调程度好,具有临床指导意义。     

术后早期经口进食对非胃肠道手术患者胃肠功能及术后住院时间影响的Meta分析

目的通过Meta分析评价术后早期经口进食对非胃肠道手术患者胃肠功能及术后住院时间的影响。方法计算机检索PubMed、The Cochrane Library、Embase、CBM、CNKI、万方数据库,同时追溯纳入研究的参考文献。运用RevMan 5.3软件进行数据处理。结果共纳入13篇随机对照试验,包括5 243例患者。Meta分析结果显示,术后早期经口进食组与常规进食组相比,恶心发生率RR=1.04,95%CI(0.79,1.38),P=0.76;呕吐发生率RR=1.00,95%CI(0.69,1.45),P=0.99;腹胀发生率RR=0.68,95%CI(0.44,1.03),P=0.07;术后便秘发生率RR=0.20,95%CI(0.12,0.32),P0.00001;术后首次排气SMD=-0.67,95%CI(-0.91,-0.42),P0.00001,首次排便时间SMD=-0.56,95%CI(-0.76,-0.36),P0.00001;术后住院时间SMD=-0.20,95%CI(-0.30,-0.10),P=0.0001。结论术后早期经口进食有利于非胃肠道手术患者胃肠功能的恢复,缩短术后住院时间。     

上消化道手术后早期经口进食的应用研究进展

文章归纳了上消化道手术后早期经口进食的关键问题。讨论了上消化道手术后早期经口进食的时机、干预、安全性和效果。在此基础上,就上消化道手术后早期经口进食的时间和具体进食方案的研究前景进行了展望,以期促进患者术后肠道功能的恢复及生活质量的提高。     

糖尿病患者罹患结直肠癌危险性的Meta分析

目的系统评价糖尿病与结直肠癌发生率的相关性,以期为糖尿病患者结直肠癌的早期筛查提供较为客观的依据。方法计算机检索MEDLINE和EMbase,检索时限为1990年1月至2010年7月,查找糖尿病患者发生结直肠癌风险性的相关队列研究,按照纳入排除标准进行文献筛选、资料提取和质量评价后,采用RevMan 4.3软件进行Meta分析。结果共纳入17项研究,包括1 690 869例研究对象。Meta分析结果显示:糖尿病患者结直肠癌发生率较对照组高,差异有统计学意义[16.50‰vs.10.13‰;OR=1.43,95%CI(1.29,1.60)]。亚组分析显示,无论男性和女性糖尿病患者,其患结直肠癌危险性均较对照组高;男性糖尿病患者风险稍高于女性(OR:1.47 vs.1.41)。结论糖尿病是结直肠癌发生的危险因素之一。     

快速康复理念下胃癌病人术后早期经口进食的研究进展

综述快速康复理念下胃癌病人术后早期经口进食的研究进展。指出早期经口进食是快速康复理念中促进胃肠功能行之有效的方法,也是目前临床研究的热点,但缺乏规范及标准。胃癌病人在手术后尽早经口进食可以加速病人康复速度,但现在针对胃癌手术后病人早期经口进食的选择时间、食物种类、方式没有一个较为统一的标准,需要更多的临床研究为制订统一、有效的进食方案提供证据。     

Reduced risk of colorectal cancer with metformin therapy in patients with type 2 diabetes: a meta-analysis

OBJECTIVE

Both in vitro and in vivo studies indicate that metformin inhibits cancer cell growth and reduces cancer risk. Recent epidemiological studies suggest that metformin therapy may reduce the risks of cancer and overall cancer mortality among patients with type 2 diabetes. However, data on its effect on colorectal cancer are limited and inconsistent. We therefore pooled data currently available to examine the association between metformin therapy and colorectal cancer among patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

The PubMed and SciVerse Scopus databases were searched to identify studies that examined the effect of metformin therapy on colorectal cancer among patients with type 2 diabetes. Summary effect estimates were derived using a random-effects meta-analysis model.

RESULTS

The analysis included five studies comprising 108,161 patients with type 2 diabetes. Metformin treatment was associated with a significantly lower risk of colorectal neoplasm (relative risk [RR] 0.63 [95% CI 0.50–0.79]; P < 0.001). After exclusion of one study that investigated colorectal adenoma, the remaining four studies comprised 107,961 diabetic patients and 589 incident colorectal cancer cases during follow-up. Metformin treatment was associated with a significantly lower risk of colorectal cancer (0.63 [0.47–0.84]; P = 0.002). There was no evidence for the presence of significant heterogeneity between the five studies (Q = 4.86, P = 0.30; I² = 18%).

CONCLUSIONS

From observational studies, metformin therapy appears to be associated with a significantly lower risk of colorectal cancer in patients with type 2 diabetes. Further investigation is warranted.Colorectal cancer is one of the most frequent malignant tumors and a leading cause of cancer-related death worldwide (1). The incidence of colorectal cancer continues to increase in economically transitioning countries such as Asia, Eastern Europe, and selected countries in South America (2,3), whereas a declining trend has been noted in several developed countries in recent years (1).Type 2 diabetes is also a common disease, and it is well established that type 2 diabetes is associated with a higher risk of colorectal cancer (4–8). Metformin is a relative of isoamylene guanidine and has been recommended as the initial glucose-lowering therapy for diabetes. Emerging evidence from both in vitro and in vivo studies indicates that metformin may inhibit cancer cell growth and reduce cancer risks. Previous research suggests that metformin may be involved in the tumor suppressor pathway by indirectly activating AMP-activated protein kinase (9)—a key sensor of cellular ATP and AMP balance—and plays a role on activating tumor suppressor genes, e.g., LKB1. Subsequent in vitro studies have shown that metformin inhibits cancer cell proliferation (10,11) and selectively kills cancer stem cells (12). Animal experiments concur with these findings. Rodent models have shown that metformin suppresses colonic epithelial proliferation and colorectal aberrant crypt foci formation (13,14). Similarly, animal models of colon cancer have shown that metformin inhibits colon carcinoma growth (11,15). Given these encouraging findings, interest has arisen that metformin could potentially serve as a new antineoplasm drug to prevent colorectal cancer.Results from preliminary studies conducted in humans are encouraging. In a short-term randomized clinical trial among nondiabetic patients with rectal aberrant crypt foci, a significant decrease in the mean number of aberrant crypt foci was observed after metformin treatment for 1 month as compared with no significant changes in the control group (16). Findings from several epidemiological studies also support an antineoplastic role of metformin on cancer risks (17,18). If metformin therapy ultimately proves effective on reducing the risk of colorectal cancer, it would likely be recommended for the overwhelming majority of diabetes patients for both blood glucose control and cancer prevention. Nonetheless, despite accumulating evidence from population studies that indicate a lower risk of cancer at large with metformin therapy (17,19,20), data on its effect on colorectal cancer are limited and inconsistent. Accordingly, we performed a meta-analysis to pool studies currently available to examine the effect of metformin treatment on colorectal cancer risk among patients with type 2 diabetes.     

大肠癌术后便秘临床分析

目的 探讨大肠癌术后便秘的发生率与手术部位及手术方式的关系.方法 回顾性分析2004年6月～2005年7月行结肠镜检查的132例大肠癌术后患者,对随访结果进行分析和总结.结果 右半结肠根治术、左半结肠根治术、乙状结肠癌根治术、直肠癌根治术患者术后便秘发生率分别为4.00％、6.25％、11.11％及32.88％;其中高位、低位、超低位直肠癌患者术后便秘发生率分别为20.00％、26.32％、41.03％(P ＜0.05);大内径吻合器与小口径吻合器吻合的患者术后便秘发生率分别为28.57％和35.56％(P ＜0.05).结论 大肠癌患者中术后发生便秘的主要为直肠癌患者,且原发肿瘤距离肛门越近便秘发生率越高;使用小内径吻合器的患者术后便秘发生率也较高.     

以口腔pH值为导向的护理对口腔癌患者术后感染的影响

目的 探讨以口腔pH值为导向的护理措施对口腔癌患者术后感染的影响。方法 采用便利抽样法，选择2019年9月至2021年6月南京医科大学附属口腔医院收治的口腔癌手术患者160例为研究对象，其中2019年9月至2020年7月的80例为对照组，2020年8月至2021年6月的80例为观察组。对照组采用生理盐水作为口腔护理液实施常规口腔护理；观察组实施基于口腔pH值为导向的护理措施，比较两组患者不同时间点口腔pH值变化情况、术后第7天口腔异味及感染发生率、口腔舒适度状况、整体住院时间。结果 两组患者入院时及术后第1天口腔pH值比较差异无统计学意义（P＞0.05）；两组患者术后第1天口腔pH值较入院时均降低，呈酸性；干预1周后：观察组口腔pH值高于对照组，恢复至正常值范围。观察组患者口腔感染及异味发生率低于对照组、口腔舒适度水平高于对照组、住院周期短于对照组，差异均有统计学意义（均P＜0.05）。结论 以口腔pH值为导向的护理措施能纠正口腔癌患者术后异常的口腔环境，降低口腔感染率、提高患者舒适度、促进患者快速康复。     

结直肠癌患者术后支持性照顾需求调查研究

目的：全面了解结直肠癌患者术后支持性照顾需求,为护理人员开展健康指导提供依据,也为护理管理者开展培训和继续教育提供方向。方法选择2012年3-7月在山西省肿瘤医院通过病理检查确诊的结直肠癌接受手术的161例患者,在澳大利亚Bonevski设计的癌症患者支持性照顾需求调查问卷的基础上增加未保肛患者适用的造口支持需求维度进行问卷调查,观察结直肠癌患者术后支持性照顾需求各维度的需求率和得分情况。结果患者6个维度平均需求率为79．12％,平均未满足率为78．63％。患者心理需求得分为（2．71±0．56）分,照顾与支持需求得分为（2．66±0．46）分,生理及日常生活需求为（2．25±0．67）分,健康信息需求得分为（1．94±0．67）分,性需求得分为（1．88±1．25）分,造口需求得分为（0．66±1．18）分。术后支持性照顾需求各维度得分比较差异有统计学意义（F＝867．81, P＜0．05）。结论护理人员应全面了解患者的需求,及时调整护理服务内容。护理管理者应根据患者需求进行护士的继续教育工作,才能有利于护理学科的发展。     

Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review

Aim. To review research on early oral feeding following elective, open colorectal surgery. Background. Fasting following gastrointestinal surgery is a traditional surgical practice, based on fears of causing postoperative complications if oral intake begins before bowel function returns, but fasting following elective surgery is questionable as a best practice. Methods. Searches in Journals@Ovid CINAHL, MEDLINE, PubMed, Web of Science and The Cochrane Library for primary studies, published during 1995–2004, used the keywords: ‘surgery’, ‘postoperative’, ‘elective, ‘colorectal’, ‘bowel, ‘colon’, ‘oral’, ‘enteral’, ‘feeding’, ‘early’, ‘traditional’. Studies of adults undergoing elective, open colorectal surgery who were allowed fluids and food before bowel function returned (early feeding) were included. Outcomes of interest were safety, tolerability, duration of gastrointestinal ileus and length of hospital stay. Critical appraisal of randomized and controlled studies was undertaken following inclusion. Results. Fifteen studies comprising 1352 patients were reviewed. All studies concluded early feeding was safe, based on complications rates. Total complications were 12·5% (range 0–25%) for 935 early feeding patients, with no increased risk of anastomotic leak, aspiration pneumonia, or bowel obstruction. For all studies an average of 86% patients (range 73–100%) tolerated early feeding. Studies demonstrating faster resolution of postoperative ileus or shorter hospitalization were associated with multimodal perioperative care, including early mobilization, epidural analgesia and comprehensive patient education. Appraisal of five randomized trials revealed no blinding and inadequate randomization. Conclusions. This review supports early oral feeding after elective, open colorectal surgery and challenges the traditional practice of fasting patients until return of bowel function. Early feeding was safe, well‐tolerated and easy to implement. Reduced length of ileus and shorter hospitalization may occur with multimodal protocols. Relevance to clinical practice. Nurses can highlight this new evidence for other health professionals, advocate development of clinical protocols featuring early feeding and participate in multi‐disciplinary, multi‐method research regarding benefits of early feeding.     

个体化术后护理在口腔癌手术患者中的应用疗效

目的:研究口腔癌手术患者应用个体化术后护理方式的临床疗效。方法:选取南京大学医学院附属口腔医院口腔癌手术患者60例,分为对照组与观察组,每组30例。观察组实施个体化的术后护理,对照组实施常规的术后护理,比较2组的并发症、生活质量、指标变化。结果:观察组生存质量评分、治疗依从性和满意度均高于对照组,而住院时间和并发症发生率显著低于对照组,2组的相关指标差异有统计学意义(P<0.05)。结论:个体化术后干预措施可提高口腔癌手术患者的生存质量评分、治疗依从性和满意度,还可以缩短住院时间和降低并发症的发生率。     

56例大肠癌术后结肠镜随访检查结果分析

目的：观察大肠癌患根治性切除术后局部复发情况。方法：患术后每隔3个月，半年，1年及2年各作一次肠镜检查及病理组织活检，以观察肿瘤复发情况。结果：大肠癌术后1－2年为好发期，其局部复发与大肠癌原发部位，Dukes分明，组织学类型及分化程度有关，结论：大肠癌患术后都应该在无症状时进行定期的内镜随访检查，以期早期发现，早期治疗术后复发的肿瘤。     

结直肠癌合并高风险性腺瘤患者内镜下手术时机分析

目的 探究结直肠癌合并高风险性腺瘤患者内镜下手术时机。方法 选取2016年1月－2021年1月该院收治的行内镜下手术的结直肠癌合并高风险性腺瘤患者共计125例,根据手术时机不同,分为A组64例和B组61例。A组：患者在手术前完成术前检查,符合手术指征后,择期进行外科结直肠癌手术,手术后3～6个月,择期进行内镜下高风险性腺瘤手术;B组：患者在手术前完成术前检查,符合手术指征后,择期进行内镜下高风险性腺瘤手术,在术后2周内,进行外科结直肠癌手术。采用自制调查量表,对患者的年龄、性别、手术出血量、手术时间、高风险性腺瘤部位、大小和个数等进行记录;通过复诊的方式,对患者病情进展进行随访。结果 两组患者在年龄、性别、手术时间及术中出血量等方面比较,差异均无统计学意义（P > 0.05）;两组患者在疾病类型、结直肠癌病灶直径、腺瘤直径、腺瘤发生部位及病理类型等方面比较,差异均无统计学意义（P > 0.05）;A组患者二次手术12例（18.8%）,多于B组的2例（3.3%）,差异有统计学意义（P < 0.05）;多因素Logistic分析得出,先择期进行外科结直肠癌手术,手术后3～6个月,择期进行内镜下高风险性腺瘤手术,是患者二次手术的独立危险因素（OR＾ = 0.324,95%CI：2.65～7.41,P < 0.05）。结论 结直肠癌合并高风险性腺瘤患者,在择期进行内镜下高风险性腺瘤手术后2周内进行外科结直肠癌手术,能够降低患者二次手术的发生率,减轻患者身体创伤,改善预后。