Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
Head Neck. 2021 Apr;43(4):1359-1368. doi: 10.1002/hed.26616. Epub 2021 Feb 4.
Timing of oral feeding following total laryngectomy is a contentious issue with highly varied practices. Multiple database search was performed to identify studies comparing outcomes of early (≤5 days) versus late (>5 days) oral feeding. Bias assessment was carried out using Cochrane bias tool. Random-effects meta-analysis was used. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The rate of pharyngocutaneous fistula (PCF) in randomized control trials (RCTs) in early versus late feeding was 15.2% versus 11.7% (RR 1.35, 95%CI [0.68-2.7], p = 0.40). The rate of PCF in the cohort studies was 14.1% versus 20.5% (RR 1.0, 95%CI [0.76-1.3], p = 0.98). The length of hospital stay was significantly shorter in the early feeding group (mean difference (days) -4.68 (-6.2 to -3.1, p < 0.0001). Early oral feeding appears to be safe and is associated with shorter hospital stay. However, the quality of evidence is low and the patient characteristics are not representative of current practices.
喉全切除术后经口进食时间是一个存在争议的问题，其做法差异很大。通过多数据库检索，确定了比较早期（≤5 天）与晚期（>5 天）经口进食结局的研究。采用 Cochrane 偏倚工具进行偏倚评估。采用随机效应荟萃分析。综述遵循系统评价和荟萃分析的 Preferred Reporting Items 指南。随机对照试验（RCT）中早期与晚期喂养的咽瘘（PCF）发生率分别为 15.2%和 11.7%（RR 1.35，95%CI [0.68-2.7]，p = 0.40）。队列研究中的 PCF 发生率分别为 14.1%和 20.5%（RR 1.0，95%CI [0.76-1.3]，p = 0.98）。早期喂养组的住院时间明显缩短（平均差值（天）-4.68（-6.2 至-3.1，p<0.0001）。早期经口进食似乎是安全的，并与较短的住院时间相关。然而，证据质量较低，患者特征与当前实践不具有代表性。
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