Leeds Institute of Biomedical and Clinical Sciences University of Leeds Leeds UK.
Faculty of Medicine and Health Sciences University of East Anglia Norwich UK.
BJS Open. 2018 Oct 1;3(1):1-10. doi: 10.1002/bjs5.102. eCollection 2019 Feb.
Ileus is common after gastrointestinal surgery and has been identified as a research priority. Several issues have limited previous research, including a widely accepted definition and agreed outcome measure. This review is the first stage in the development of a core outcome set for the return of bowel function after gastrointestinal surgery. It aims to characterize the extent of variation in current outcome reporting.
A systematic search of MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library was performed for 1990-2017. RCTs of adults undergoing gastrointestinal surgery, including at least one reported measure relating to return of bowel function, were eligible. Trial registries were searched across the same period for ongoing and completed (but not published) RCTs. Definitions of ileus and outcome measures describing the return of bowel function were extracted.
Of 5670 manuscripts screened, 215 (reporting 217 RCTs) were eligible. Most RCTs involved patients undergoing colorectal surgery (161 of 217, 74·2 per cent). A total of 784 outcomes were identified across all published RCTs, comprising 73 measures (clinical: 63, 86 per cent; radiological: 6, 8 per cent; physiological: 4, 5 per cent). The most commonly reported outcome measure was 'time to first passage of flatus' (140 of 217, 64·5 per cent). The outcomes 'ileus' and 'prolonged ileus' were defined infrequently and variably.
Outcome reporting for the return of bowel function after gastrointestinal surgery is variable and not fit for purpose. An agreed core outcome set will improve the consistency, reliability and clinical value of future studies.
胃肠道手术后常会发生肠梗阻，且已被确定为研究重点。先前的研究受到了几个问题的限制，包括尚未达成共识的定义和公认的结局测量指标。本综述是胃肠道手术后肠道功能恢复的核心结局集开发的第一阶段，旨在明确当前结局报告的差异程度。
对 1990 年至 2017 年间的 MEDLINE、Embase、CINAHL（护理与联合健康文献累积索引）和 Cochrane 图书馆进行了系统检索。纳入对象为行胃肠道手术的成年人 RCT，且至少有一项报告与肠道功能恢复相关的结局测量指标。同期检索临床试验注册库，纳入正在进行和已完成（但尚未发表）的 RCT。提取肠梗阻的定义和描述肠道功能恢复的结局测量指标。
共筛选出 5670 篇文献，其中 215 篇（报道了 217 项 RCT）符合纳入标准。大多数 RCT 涉及接受结直肠手术的患者（217 项 RCT 中的 161 项，74.2%）。所有已发表 RCT 共识别出 784 个结局，包含 73 个指标（临床：63 个，86.0%；影像学：6 个，8.0%；生理学：4 个，5.0%）。最常报告的结局测量指标是“首次排气时间”（217 项 RCT 中的 140 项，64.5%）。“肠梗阻”和“延长性肠梗阻”的定义频率较低且差异较大。
胃肠道手术后肠道功能恢复的结局报告存在差异，不适合实际应用。一个公认的核心结局集将提高未来研究的一致性、可靠性和临床价值。
