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针刺治疗癌症术后胃肠功能障碍：一项系统评价与Meta分析

Acupuncture for postoperative gastrointestinal dysfunction in cancer: a systematic review and meta-analysis.

作者信息

Lin Dezhi, Ou Yangxu, Li Longlong, Wu Kexin, Zhang Qiang, Yan Jiayin, Kuang Kunlin, Peng Dezhong

机构信息

School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

出版信息

Front Oncol. 2023 Jun 9;13:1184228. doi: 10.3389/fonc.2023.1184228. eCollection 2023.

DOI:10.3389/fonc.2023.1184228
PMID:37361600
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10289226/
Abstract

BACKGROUND: Postoperative gastrointestinal dysfunction (PGD) in cancer is the commonest and most severe postoperative complication in patients with cancer. Acupuncture has been widely used for PGD in cancer. This study aimed to evaluate the efficacy and safety of acupuncture for PGD in cancer. METHODS: We comprehensively searched eight randomised controlled trials (RCTs) of acupuncture for PGD in cancer published until November 2022. Time to first flatus (TFF) and time to first defecation (TFD) were the primary outcomes, and time to bowel sound recovery (TBSR) and the length of hospital stay (LOS) were the secondary outcomes. The Cochrane Collaboration Risk of Bias Tool was used to assess the quality of the RCTs, and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) system was used to evaluate the certainty of the evidence. The meta-analysis was performed using RevMan 5.4, and a publication bias test was performed using Stata 15.1. RESULTS: Sixteen RCTs involving 877 participants were included in this study. The meta-analysis indicated that acupuncture could effectively reduce the TFF, TFD, and TBSR compared with routine treatment (RT), sham acupuncture, and enhanced recovery after surgery (ERAS). However, acupuncture did not shorten the LOS compared with RT and ERAS. The subgroup analysis revealed that acupuncture could significantly reduce the TFF and TFD. Acupuncture effectively reduced the TFF and TFD in all cancer types included in this review. Besides, local acupoints in combination with distal acupoints could reduce the TFF and TFD, and distal-proximal acupoints could significantly reduce the TFD. No trial reported adverse events of acupuncture. CONCLUSIONS: Acupuncture is an effective and relatively safe modality for treating PGD in cancer. We anticipate that there will be more high-quality RCTs involving more acupuncture techniques and cancer types, focusing on combining acupoints for PGD in cancer, further determining the effectiveness and safety of acupuncture for PGD in patients with cancer outside China. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero, identifier CRD42022371219.

摘要

背景：癌症术后胃肠功能障碍（PGD）是癌症患者最常见、最严重的术后并发症。针灸已被广泛用于治疗癌症患者的PGD。本研究旨在评估针灸治疗癌症患者PGD的疗效和安全性。 方法：我们全面检索了截至2022年11月发表的8项关于针灸治疗癌症患者PGD的随机对照试验（RCT）。首次排气时间（TFF）和首次排便时间（TFD）为主要结局指标，肠鸣音恢复时间（TBSR）和住院时间（LOS）为次要结局指标。采用Cochrane协作网偏倚风险工具评估RCT的质量，使用推荐分级的评估、制定与评价（GRADE）系统评估证据的确定性。使用RevMan 5.4进行荟萃分析，使用Stata 15.1进行发表偏倚检验。 结果：本研究纳入了16项RCT，共877名参与者。荟萃分析表明，与常规治疗（RT）、假针灸和术后加速康复（ERAS）相比，针灸能有效缩短TFF、TFD和TBSR。然而，与RT和ERAS相比，针灸并未缩短LOS。亚组分析显示，针灸能显著缩短TFF和TFD。在本综述纳入的所有癌症类型中，针灸均能有效缩短TFF和TFD。此外，局部穴位与远端穴位联合应用可缩短TFF和TFD，远端-近端穴位联合应用可显著缩短TFD。没有试验报告针灸的不良事件。 结论：针灸是治疗癌症患者PGD的一种有效且相对安全的方法。我们预计将会有更多高质量的RCT，涉及更多的针灸技术和癌症类型，重点关注癌症患者PGD的穴位配伍，进一步确定针灸在中国以外癌症患者中治疗PGD的有效性和安全性。 系统评价注册：https://www.crd.york.ac.uk/prospero，标识符CRD42022371219。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8623/10289226/3bbffcfd4d4e/fonc-13-1184228-g007.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8623/10289226/4c2713b6b1cf/fonc-13-1184228-g001.jpg
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本文引用的文献

[1]
Effectiveness and safety of acupuncture for postoperative ileus following gastrointestinal surgery: A systematic review and meta-analysis.

PLoS One. 2022

[2]
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Zhongguo Zhen Jiu. 2022-5-12

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