Zhang Lei, Cheng Yusheng, Li Huizi, Zhou Yufeng, Sun Bo, Xu Leibo
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Hepatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Ann Surg Treat Res. 2018 Jul;95(1):7-15. doi: 10.4174/astr.2018.95.1.7. Epub 2018 Jun 26.
Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery.
PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs).
Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, -0.41; 95% confidence interval [CI], -0.66 to -0.16; P = 0.001) with significant heterogeneity (I = 71%, P = 0.004), and bowel movement (MD, -0.65; 95% CI, -0.97 to -0.32; P < 0.001) without significant heterogeneity (I = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results.
These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.
肠道功能障碍是腹部手术后患者最常见的并发症之一。大建中汤（DKT），一种传统草药，最近被用于改善术后肠道功能障碍。本荟萃分析的目的是评估DKT改善腹部手术后肠道功能障碍的疗效。
系统检索PubMed、Embase和Cochrane图书馆，以识别接受腹部手术的成年患者的随机对照试验（RCT），这些患者被随机分配接受DKT和安慰剂治疗。主要结局包括首次术后排气或排便时间。我们使用随机效应模型计算汇总平均差（MDs）及95%置信区间（CIs）。
我们的研究纳入了9项RCT，共1212例患者（DKT组618例，对照组594例）。与对照组相比，DKT可通过缩短首次术后排气时间（MD，-0.41；95%置信区间[CI]，-0.66至-0.16；P = 0.001）有效改善术后肠道功能障碍，存在显著异质性（I² = 71%，P = 0.004），以及排便时间（MD，-0.65；95% CI，-0.97至-0.32；P < 0.001），无显著异质性（I² = 40%，P = 0.14）。按手术指征和手术类型进行的敏感性分析得出了相似的结果。
这些数据提供了有限的证据表明DKT在改善腹部手术后肠道功能障碍方面具有疗效。然而，由于纳入研究的异质性，结果应谨慎解释。因此，DKT改善术后肠道功能障碍的疗效值得进一步研究。
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