Yang Jing-Wen, Shao Jia-Kai, Wang Yu, Liu Qian, Liang Jian-Wei, Yan Shi-Yan, Zhou Si-Cheng, Yang Na-Na, Wang Li-Qiong, Shi Guang-Xia, Pei Wei, Liu Cun-Zhi
International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No.11 Bei San Huan Dong Lu, Chaoyang District, Beijing 100021, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Pan-Jia-Yuan South Lane, Chaoyang District, Beijing 100021, China.
EClinicalMedicine. 2022 May 27;49:101472. doi: 10.1016/j.eclinm.2022.101472. eCollection 2022 Jul.
BACKGROUND: Postoperative ileus after colorectal surgery is a frequent problem that significantly delays recovery, increases perioperative costs, and negatively impacts on daily life, physical and psychosocial functioning, and wellbeing. We investigated the effect of acupuncture at different single acupoint combined with standard care on postoperative ileus. METHODS: In this single-centre, three-arm, prospective, randomised trial, we enrolled patients with primary colorectal cancer undergoing elective colorectal resection at Cancer Hospital Chinese Academy of Medical Science in Beijing, China. Patients were randomly assigned (1:1:1) to receive either electroacupuncture (EA) at ST36 or ST25 combined with standard care (two EA groups) once daily from post-operative days 1-4, or standard care alone (standard care group). The co-primary outcomes were time to first flatus and time to defecation assessed in the intention-to-treat population. This study is registered with Chictr.org.cn, ChiCTR1900027466. FINDING: Between Nov 15, 2019, and Sep 30, 2020, 129 patients were assessed for eligibility, 105 patients (35 patients per group) were enrolled and included in the intention-to-treat analysis. After receiving EA at ST36, the time to first flatus and defecation were shorter (between-group difference -10.98 [97.5% CI -21.41 to -0.56], = 0·02 for flatus; -25.41 [-47.89 to -2.93], = 0·02 for defecation). However, we did not observe a significant difference in time to first flatus and defecation between the EA at ST25 group and standard care group (between-group difference -5.54 [97.5% CI -15.78 to 4.70], = 0·26 for flatus; -17.69 [-40.33 to 4.95], = 0·08 for defecation). There were no serious adverse events. INTERPRETATION: Compared with standard care alone, standard care combined with EA at ST36, but not ST25, significantly enhances bowel function recovery in a postoperative setting to patients with colorectal cancer with laparoscopic elective colorectal resection. FUNDING: The National Key R&D Program of China (No: 2019YFC1712100) and the National Science Fund for Distinguished Young Scholars (No:81825024).
背景：结直肠手术后的术后肠梗阻是一个常见问题，会显著延迟康复、增加围手术期费用，并对日常生活、身体和心理社会功能以及健康产生负面影响。我们研究了不同单穴位针刺联合标准护理对术后肠梗阻的影响。 方法：在这项单中心、三臂、前瞻性随机试验中，我们纳入了在中国北京中国医学科学院肿瘤医院接受择期结直肠切除术的原发性结直肠癌患者。患者被随机分配（1:1:1），从术后第1天至第4天每天接受一次足三里（ST36）或天枢（ST25）电针（EA）联合标准护理（两个电针组），或仅接受标准护理（标准护理组）。共同主要结局是在意向性治疗人群中评估首次排气时间和排便时间。本研究已在中国临床试验注册中心（Chictr.org.cn）注册，注册号为ChiCTR1900027466。 结果：在2019年11月15日至2020年9月30日期间，评估了129例患者的 eligibility，105例患者（每组35例）被纳入并进行意向性治疗分析。接受足三里（ST36）电针后，首次排气和排便时间缩短（组间差异 -10.98 [97.5%CI -21.41至-0.56]，排气P = 0.02；-25.41 [-47.89至-2.93]，排便P = 0.02）。然而，我们未观察到天枢（ST25）电针组与标准护理组之间在首次排气和排便时间上有显著差异（组间差异 -5.54 [97.5%CI -15.78至4.70]，排气P = 0.26；-17.69 [-40.33至4.95]，排便P = 0.08）。未发生严重不良事件。 解读：与单纯标准护理相比，标准护理联合足三里（ST36）电针而非天枢（ST25）电针可显著促进接受腹腔镜择期结直肠切除术的结直肠癌患者术后肠道功能恢复。 资助：国家重点研发计划（编号：2019YFC1712100）和国家杰出青年科学基金（编号：81825024）。
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