Lei Qiucheng, Wang Xinying, Tan Shanjun, Xia Xianfeng, Zheng Huazhen, Wu Chao
Department of General Surgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China.
Dig Surg. 2014;31(4-5):392-9. doi: 10.1159/000369219. Epub 2014 Dec 24.
BACKGROUND/AIMS: The role of fast-track programs in hepatectomy is unclear. This meta-analysis aimed to evaluate the efficacy and safety of fast-track programs versus traditional care.
We searched Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs) comparing fast-track with traditional care in hepatectomy. Length of hospital stay, time to first flatus, postoperative complications, operating time, and intraoperative blood loss were assessed. Meta-analyses were performed using RevMan 5.2 software.
Four original RCTs with 372 patients were included: 187 in the fast-track and 185 in the traditional care group. Fast-track patients had shorter hospital stay (WMD -2.32; 95% CI, -3.54 to -1.11; p < 0.001) and time to first flatus (WMD -0.99; 95% CI, -1.15 to -0.84; p < 0.001), and less postoperative complications (RR 0.66; 95% CI, 0.47 to 0.93; p < 0.05). However, there was significant heterogeneity between the studies regarding hospital stay (I(2) = 88%; p < 0.001). Operating time and intraoperative blood loss were not different.
Patients in fast-track programs had less time to first flatus and postoperative complications compared to traditional care. Fast-track programs may reduce the length of hospital stay. Larger, higher quality prospective RCTs are necessary to draw more robust conclusions.
背景/目的：快速康复计划在肝切除术中的作用尚不清楚。本荟萃分析旨在评估快速康复计划与传统护理相比的疗效和安全性。
我们在PubMed、Embase、Cochrane对照试验中央注册库和谷歌学术中搜索了相关的随机对照试验（RCT），比较肝切除术中快速康复与传统护理的效果。评估住院时间、首次排气时间、术后并发症、手术时间和术中失血量。使用RevMan 5.2软件进行荟萃分析。
纳入了4项原始RCT，共372例患者：快速康复组187例，传统护理组185例。快速康复组患者的住院时间较短（加权均数差-2.32；95%置信区间，-3.54至-1.11；p<0.001），首次排气时间较短（加权均数差-0.99；95%置信区间，-1.15至-0.84；p<0.001），术后并发症较少（风险比0.66；95%置信区间，0.47至0.93；p<0.05）。然而，在住院时间方面，各研究之间存在显著异质性（I² = 88%；p<0.001）。手术时间和术中失血量没有差异。
与传统护理相比，快速康复计划中的患者首次排气时间和术后并发症更少。快速康复计划可能会缩短住院时间。需要进行更大规模、更高质量的前瞻性RCT，以得出更可靠的结论。
