Ni Tian-Gen, Yang Han-Teng, Zhang Hao, Meng Hai-Peng, Li Bo
Tian-Gen Ni, Han-Teng Yang, Hao Zhang, Hai-Peng Meng, Bo Li, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2015 Aug 14;21(30):9209-16. doi: 10.3748/wjg.v21.i30.9209.
To evaluate the impact of enhanced recovery after surgery (ERAS) programs in comparison with traditional care on liver surgery outcomes.
The PubMed, EMBASE, CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria: (1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery; (2) outcome measures including complications, recovery of bowel function, and hospital length of stay; and (3) RCTs. The following exclusion criteria were applied: (1) the study was not an RCT; (2) the study did not compare ERAS with traditional care; (3) the study reported on emergency, non-elective or transplantation surgery; and (4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.
Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases, patients presented with benign diseases, while the remaining 713 cases had liver cancer. Of the five studies, three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group, while 369 patients were in the traditional care group. Compared with traditional care, ERAS programs were associated with significantly decreased overall complications (RR = 0.66; 95%CI: 0.49-0.88; P = 0.005), grade I complications (RR = 0.51; 95%CI: 0.33-0.79; P = 0.003), and hospital length of stay [WMD = -2.77 d, 95%CI: -3.87-(-1.66); P < 0.00001]. Similarly, ERAS programs were associated with decreased time to first flatus [WMD = -19.69 h, 95%CI: -34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade II-V complications between the two groups.
ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.
评估与传统护理相比，手术加速康复（ERAS）方案对肝脏手术结局的影响。
检索PubMed、EMBASE、中国知网和Cochrane对照试验中心注册库数据库，以查找比较ERAS方案与传统护理对接受肝脏手术患者影响的随机对照试验（RCT）。纳入荟萃分析的研究均符合以下所有纳入标准：（1）评估ERAS与传统护理对接受择期开放性或腹腔镜肝脏手术的成年患者的影响；（2）结局指标包括并发症、肠功能恢复情况和住院时间；（3）RCT。应用以下排除标准：（1）该研究不是RCT；（2）该研究未比较ERAS与传统护理；（3）该研究报道的是急诊、非择期或移植手术；（4）该研究仅包含在国内或国际会议上发表摘要的未发表研究。主要结局为并发症。次要结局为住院时间和首次排气时间。
荟萃分析纳入了5项包含723例患者的RCT。在723例患者中，10例患有良性疾病，其余713例患有肝癌。在这5项研究中，3项以英文发表，2项以中文发表。ERAS组有354例患者，传统护理组有369例患者。与传统护理相比，ERAS方案与总体并发症显著减少相关（RR = 0.66；95%CI：0.49 - 0.88；P = 0.005），I级并发症（RR = 0.51；95%CI：0.33 - 0.79；P = 0.003），以及住院时间[WMD = -2.77天，95%CI：-3.87 - (-1.66)；P < 0.00001]。同样，ERAS方案与首次排气时间减少相关[WMD = -19.69小时，95%CI：-34.63 - (-4.74)；P < 0.0001]。两组之间II - V级并发症无统计学显著差异。
ERAS在肝脏手术中是一种安全有效的方案。未来的研究应确定优化肝脏手术术后结局的有效要素。
