Feng Dechao, Liu Shengzhuo, Lu Yiping, Wei Wuran, Han Ping
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Transl Androl Urol. 2020 Aug;9(4):1743-1753. doi: 10.21037/tau-19-941.
The aim of this study was to evaluate the effect of enhanced recovery after surgery (ERAS) on perioperative outcomes in patients undergoing radical cystectomy (RC) and ileal urinary diversion (IUD). We performed a literature search of PubMed, Web of Science, EMBASE, the Cochrane Library and three main Chinese databases (WANFANG, CNKI and VIP) in December 2019 without language restrictions. Two reviewers independently selected studies, evaluated methodological quality and extracted data using Cochrane Collaboration's tools. Efficacy was assessed by the time to first flatus, first bowel movement, and hospitalization time. Safety was assessed by 30-day readmission and complications after surgery. Our searches identified 6 studies, including 628 patients. A total of 323 (51%) patients took ERAS. We observed that ERAS reduced the time to first flatus [standard mean difference (SMD): -1.65, 95% CI: -2.63 to -0.68, P=0.0009], first bowel movement (SMD: -1.14, 95% CI: -1.78 to -0.50, P=0.0005), and hospitalization time (MD: -4.09, 95% CI: -6.34 to -1.85, P=0.0004). We did not detect significant difference in terms of 30-day readmission [relative risk (RR): 1.33, 95% CI: 0.61-2.88, P=0.48] and postoperative complications (RR: 0.91, 95% CI: 0.65-1.26, P=0.56) between ERAS and conventional recovery after surgery (CRAS). Our findings indicated that ERAS protocols throughout the perioperative period of RC with IUD might reduce hospitalization expenses and contribute to higher turnover ward, more efficient utilization of medical resources and lower risk of nosocomial infection as a result of shorter length of stay. Besides, early rehabilitation of gastrointestinal function might not only facilitate wound healing and early mobilization, thereby reducing the incidence of basic complications such as cardiopulmonary disease, but also improve patients' psychological trauma and stress response, increase self-confidence and motivation in treatments, and then lead to unexpected benefits. Further large volume, multicenter randomized controlled studies are warranted before making the final clinical guidelines.
本研究旨在评估加速康复外科（ERAS）对接受根治性膀胱切除术（RC）和回肠代膀胱术（IUD）患者围手术期结局的影响。2019年12月，我们对PubMed、Web of Science、EMBASE、Cochrane图书馆以及三个主要中文数据库（万方、知网和维普）进行了文献检索，无语言限制。两名评审员独立选择研究、评估方法学质量并使用Cochrane协作组的工具提取数据。通过首次排气时间、首次排便时间和住院时间评估疗效。通过术后30天再入院率和并发症评估安全性。我们的检索共识别出6项研究，包括628例患者。共有323例（51%）患者采用了ERAS。我们观察到，ERAS缩短了首次排气时间[标准均差（SMD）：-1.65，95%置信区间（CI）：-2.63至-0.68，P=0.0009]、首次排便时间（SMD：-1.14，95%CI：-1.78至-0.50，P=0.0005）和住院时间（MD：-4.09，95%CI：-6.34至-1.85，P=0.0004）。我们未发现ERAS与传统术后康复（CRAS）在30天再入院率[相对危险度（RR）：1.33，95%CI：0.61-2.88，P=0.48]和术后并发症（RR：0.91，95%CI：0.65-1.26，P=0.56）方面存在显著差异。我们的研究结果表明，在RC伴IUD的围手术期采用ERAS方案可能会降低住院费用，有助于提高病房周转率、更有效地利用医疗资源，并因住院时间缩短而降低医院感染风险。此外，胃肠道功能的早期恢复不仅可能促进伤口愈合和早期活动，从而降低心肺疾病等基本并发症的发生率，还可能改善患者的心理创伤和应激反应，增强治疗的自信心和积极性，进而带来意想不到的益处。在制定最终临床指南之前，有必要进行进一步的大样本、多中心随机对照研究。
