Department of Hepatobiliary Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
Department of Hepatobiliary Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom.
HPB (Oxford). 2019 Jul;21(7):793-801. doi: 10.1016/j.hpb.2019.01.005. Epub 2019 Feb 14.
The need for nutritional support following pancreaticoduodenectomy is well recognised due to the high prevalence of malnutrition, but the optimal delivery route is still debated. This meta-analysis evaluated postoperative outcomes in patients receiving enteral or parenteral nutrition.
EMBASE, MEDLINE and Cochrane databases were searched to identify randomised controlled trials comparing enteral and parenteral nutrition in patients undergoing pancreaticoduodenectomy. The primary outcome measure was delayed gastric emptying (DGE). Secondary outcome measures included length of hospital stay (LOS); postoperative pancreatic fistula (POPF); post-pancreaticoduodenectomy haemorrhage (PPH); and infective complications (IC).
Five randomised controlled trials met inclusion criteria and reported on 690 patients (enteral nutrition n = 383; and parenteral nutrition n = 307). Median age was 61.5 years (interquartile range 60.1-63.6). The pooled relative risk (RR) of the primary outcome, DGE, was 0.97 (95% confidence interval (CI) 0.52-1.81, p = 0.93). There were no statistically significant difference in the secondary outcome measures of POPF (RR 1.07, 95% CI 0.42-2.76, p = 0.88); PPH (RR 0.67, 95% CI 0.31-1.48, p = 0.33) and infectious complications (RR 0.76, 95% CI 0.50-1.17, p = 0.22). However, LOS favoured enteral nutrition, weighted mean difference -1.63 days (95% CI -2.80, -0.46, p = 0.006).
EN is associated with a significantly shorter LOS compared to PN in patients undergoing pancreaticoduodenectomy.
由于营养不良的高发病率，人们已经认识到胰腺十二指肠切除术后需要营养支持，但最佳的输送途径仍存在争议。这项荟萃分析评估了接受肠内或肠外营养的患者的术后结果。
检索了 EMBASE、MEDLINE 和 Cochrane 数据库，以确定比较胰腺十二指肠切除术后接受肠内和肠外营养的患者的随机对照试验。主要观察指标是胃排空延迟（DGE）。次要观察指标包括住院时间（LOS）；术后胰腺瘘（POPF）；胰十二指肠切除术后出血（PPH）；和感染性并发症（IC）。
五项随机对照试验符合纳入标准，报告了 690 名患者（肠内营养组 n=383；肠外营养组 n=307）。中位年龄为 61.5 岁（四分位间距 60.1-63.6）。主要结局，DGE 的合并相对风险（RR）为 0.97（95%置信区间（CI）0.52-1.81，p=0.93）。在次要结局指标中，POPF（RR 1.07，95%CI 0.42-2.76，p=0.88）；PPH（RR 0.67，95%CI 0.31-1.48，p=0.33）和感染性并发症（RR 0.76，95%CI 0.50-1.17，p=0.22）无统计学显著差异。然而，EN 有利于肠内营养，加权平均差异-1.63 天（95%CI-2.80，-0.46，p=0.006）。
与 PN 相比，EN 与胰腺十二指肠切除术后患者的 LOS 显著缩短相关。
