Chen Yulian, Fu Mingru, Huang Guifen, Chen Jiao
Reproductive Center, Haikou Maternal and Child Health Hospital, Haikou, China.
Department of Gynecology, Danzhou People's Hospital, Danzhou, China.
Gland Surg. 2022 May;11(5):837-846. doi: 10.21037/gs-22-168.
Surgery is the recommended treatment for uterine leiomyoma but it still has issues like postoperative complications and slow recovery. The enhanced recovery after surgery (ERAS) protocol could probably reduce traumatic stress and promote the rapid postoperative recovery of patients, but there are controversies for the results of different studies. This meta-analysis was performed to resolve the controversies and provide evidence for the application of ERAS in gynecology.
The PubMed, Embase, Ovid, CNKI (China), Wanfang Data (China), and Google Scholar databases were searched to recruit all studies on the application of ERAS in laparoscopic myomectomy up to November 2021. The inclusion criteria of studies was established according to the PICOS principles. the Cochrane RoB 2.0 and Newcastle-Ottawa Scale (NOS) scale were used to assess the bias of the studies, RevMan 5.3 software was used for meta-analysis.
Ten studies that met the criteria were finally included with 1,441 participants. Eight of them were randomized controlled trials (RCTs) and two were cohort studies, all of them were with low level of bias. Meta-analysis showed that ERAS protocol after laparoscopic myomectomy could significantly shorten the first time getting out of bed after surgery [mean difference (MD) =-4.85; 95% confidence interval (CI): (-7.35, -2.36); P=0.0001], the first defecation time after surgery [MD =-4.69; 95% CI: (-5.68, -3.69); P<0.00001], and the postoperative hospital stay [MD =-1.32, 95% CI: (-2.08, -0.56); P=0.0007]. It could also markedly reduce the patient readmission rate [odds ratio (OR) =0.42; 95% CI: (0.23, 0.76); P=0.004], and notably reduced the incidence of complications [OR =0.37; 95% CI: (0.22, 0.61); Z=3.82; P=0.0001]. Yet, the cost of the ERAS protocol was not significantly different from that of routine care [MD =-127.76, 95% CI: (-997.19, 741.66); P=0.77].
The application of ERAS protocol after gynecological laparoscopic myomectomy can shorten the first defecation time, first time out of bed, hospital stay, and reduce the readmission rate as well as the incidence of postoperative complications, without additional costs. But still there was heterogeneity among the studies, the topic still deserved further exploration.
手术是子宫平滑肌瘤的推荐治疗方法，但仍存在术后并发症和恢复缓慢等问题。术后加速康复（ERAS）方案可能会减轻创伤应激，促进患者术后快速康复，但不同研究结果存在争议。本荟萃分析旨在解决这些争议，并为ERAS在妇科中的应用提供证据。
检索PubMed、Embase、Ovid、中国知网（CNKI）、万方数据（中国）和谷歌学术数据库，纳入截至2021年11月所有关于ERAS在腹腔镜子宫肌瘤切除术中应用的研究。根据PICOS原则制定研究纳入标准。采用Cochrane RoB 2.0和纽卡斯尔-渥太华量表（NOS）评估研究偏倚，使用RevMan 5.3软件进行荟萃分析。
最终纳入10项符合标准的研究，共1441名参与者。其中8项为随机对照试验（RCT），2项为队列研究，所有研究偏倚水平均较低。荟萃分析显示，腹腔镜子宫肌瘤切除术后采用ERAS方案可显著缩短术后首次下床时间[平均差（MD）=-4.85；95%置信区间（CI）：（-7.35，-2.36）；P=0.0001]、术后首次排便时间[MD=-4.69；95%CI：（-5.68，-3.69）；P<(displaystyle 0.00001)]和术后住院时间[MD=-1.32，95%CI：（-2.08，-0.56）；P=0.0007]。还可显著降低患者再入院率[比值比（OR）=0.42；95%CI：（0.23，0.76）；P=0.004]，并显著降低并发症发生率[OR=0.37；95%CI：（0.22，0.61）；Z=3.82；P=0.0001]。然而，ERAS方案的费用与常规护理相比无显著差异[MD=-127.76，95%CI：（-997.19，741.66）；P=0.77]。
妇科腹腔镜子宫肌瘤切除术后应用ERAS方案可缩短首次排便时间、首次下床时间和住院时间，降低再入院率及术后并发症发生率，且无额外费用。但研究间仍存在异质性，该话题仍值得进一步探索。
