Wang Cheng, Zheng Guoqun, Zhang Wenlong, Zhang Fabiao, Lv Shangdong, Wang Aidong, Fang Zheping
Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, 150 Ximen Street, Linhai, 317000, China.
J Gastrointest Surg. 2017 Mar;21(3):472-486. doi: 10.1007/s11605-017-3360-y. Epub 2017 Jan 18.
Due to the limited number of high-quality randomized controlled trials on enhanced recovery after surgery for hepatectomy, previous reviews have not been sufficiently comprehensive. Our objectives were to evaluate and compare the safety and efficacy of enhanced recovery after surgery programs and traditional care in patients undergoing open or laparoscopic surgery and to assess the optimized items for hepatectomy.
We searched the PubMed, Embase, and the Cochrane Library databases for all the relevant studies regardless of study design. We assessed the methodological quality of the included studies and excluded studies of poor quality. We performed a meta-analysis using RevMan 5.3 software.
In total, 19 original studies with 2575 patients, including four randomized controlled trials and 15 non-randomized controlled trials, were analyzed. The meta-analysis demonstrated that enhanced recovery after surgery programs could reduce morbidity, hospital stays and cost, blood loss, and time to bowel function recovery for both open and laparoscopic surgery without increasing mortality, readmission rate, or transfusion rate. Twelve items were essential for liver surgery.
Enhanced recovery after surgery programs for hepatectomy are feasible and efficient. Further studies should optimize perioperative outcomes for liver surgery.
由于肝切除术后加速康复的高质量随机对照试验数量有限，以往的综述不够全面。我们的目的是评估和比较接受开放手术或腹腔镜手术患者的术后加速康复方案与传统护理的安全性和有效性，并评估肝切除的优化项目。
我们检索了PubMed、Embase和Cochrane图书馆数据库，纳入所有相关研究，不考虑研究设计。我们评估了纳入研究的方法学质量，并排除了质量较差的研究。我们使用RevMan 5.3软件进行了荟萃分析。
共分析了19项原始研究，涉及2575例患者，包括4项随机对照试验和15项非随机对照试验。荟萃分析表明，术后加速康复方案可降低开放手术和腹腔镜手术的发病率、住院时间和费用、失血量以及肠功能恢复时间，且不增加死亡率、再入院率或输血率。12项措施对肝脏手术至关重要。
肝切除术后加速康复方案是可行且有效的。进一步的研究应优化肝脏手术的围手术期结局。
