Peng J, Cai J, Niu Z-X, Chen L-Q
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Dis Esophagus. 2016 May;29(4):333-41. doi: 10.1111/dote.12337. Epub 2015 Feb 27.
Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.
据报道，食管癌患者在食管切除术后早期进行肠内营养（EN）比肠外营养（PN）能带来更好的康复效果。然而，尚未得出确凿结论。因此，我们进行了一项荟萃分析，以比较接受食管切除术的食管癌患者术后的EN和PN。检索了三个电子数据库，寻找符合条件的研究纳入荟萃分析。使用固定效应模型和随机效应模型计算汇总相对风险/加权平均差（RR/WMD）估计值及相应的95%置信区间（CI）。十项研究符合纳入标准。分析表明，与PN相比，术后早期EN可显著降低肺部并发症（RR = 0.37，95%CI = 0.22 - 0.62，P = 0.00，异质性检验：I(2) = 0.0%，P = 0.89）和吻合口漏（RR = 0.46，95%CI = 0.22 - 0.96，P = 0.04，异质性检验：I(2) = 0.0%，P = 0.66）的发生率。术后第8天，EN组的白蛋白水平（WMD = 1.84，95%CI = 0.47 - 3.21，P = 0.01，异质性检验：I(2) = 84.5%，P = 0.00）和前白蛋白水平（WMD = 12.96，95%CI = 3.63 - 22.29，P = 0.01，异质性检验：I(2) = 0.0%，P = 0.63）高于PN组。然而，这两种方法在消化并发症方面没有差异（RR = 1.30，95%CI = 0.79 - 2.13，P = 0.30，异质性检验：I(2) = 0.0%，P = 0.97）。对于接受食管切除术的食管癌患者，术后早期EN支持可降低严重并发症（如肺部并发症和吻合口漏）的发生率，并使患者维持比肠外营养支持更好的营养状态。
