肝癌肝切除术后加速康复外科方案的安全性与有效性

Safety and efficacy of the enhanced recovery after surgery protocol in hepatectomy for liver cancer.

作者信息

Lv Quan, Xiang Ying-Chun, Qiu Yan-Yu, Xiang Zheng

机构信息

Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, , 100730, China.

出版信息

Clin Res Hepatol Gastroenterol. 2024 Dec;48(10):102493. doi: 10.1016/j.clinre.2024.102493. Epub 2024 Nov 20.

DOI:10.1016/j.clinre.2024.102493

PMID:39571193

Abstract

PURPOSE

The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer.

MATERIALS AND METHODS

We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software.

RESULTS

Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I² = 54.89 %, 95 % confidence interval (CI) = 0.33-0.74, P = 0.00], postoperative Clavien-Dindo Grade 1-2 complications (OR = 0.39, I² = 55.14 %, 95 %CI = 0.23-0.69, P = 0.00), Clavien-Dindo Grade 3-4 complications (OR = 0.56, I² = 0.00 %, 95 %CI = 0.38-0.83, P = 0.00) , pneumonia (OR = 0.34, I² = 0.00 %, 95 %CI = 0.15-0.76, P = 0.01), ascites (OR = 0.25, I² = 0.00 %, 95 %CI = 0.09-0.68, P = 0.01), vomit (OR = 0.39, I² = 0.00 %, 95 %CI = 0.21-0.73, P = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I² = 0.00 %, 95 %CI = 1.15-2.47, P = 0.01], PLOS (MD = -0.42, I² = 94.87 %, 95 %CI = -0.86-0.03, P = 0.07), duration of abdominal drain (MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42, P = 0.00), and hospital readmission (OR = 0.44, I² = 0.00 %, 95 %CI = 0.23-0.85, P = 0.01) compared to the non-ERAS group.

CONCLUSION

For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.

摘要

目的

本研究旨在评估手术加速康复（ERAS）方案在肝癌肝切除患者中的疗效和安全性。

材料与方法

我们检索了三个数据库，包括PubMed、Embase和Cochrane图书馆数据库，检索时间从建库至2023年4月25日。观察指标为术后并发症和术后住院时间（PLOS）。本研究使用Stata（V. 16.0）软件进行。

结果

本研究纳入了12项涉及1892例患者的调查。与非ERAS组相比，ERAS组的总体术后并发症发生率较低[比值比（OR）=0.49，I² = 54.89%，95%置信区间（CI）=0.33 - 0.74，P = 0.00]，术后Clavien-Dindo 1 - 2级并发症发生率（OR = 0.39，I² = 55.14%，95%CI = 0.23 - 0.69，P = 0.00），Clavien-Dindo 3 - 4级并发症发生率（OR = 0.56，I² = 0.00%，95%CI = 0.38 - 0.83，P = 0.00），肺炎发生率（OR = 0.34，I² = 0.00%，95%CI = 0.15 - 0.76，P = 0.01），腹水发生率（OR = 0.25，I² = 0.00%，95%CI = 0.09 - 0.68，P = 0.01），呕吐发生率（OR = 0.39，I² = 0.00%，95%CI = 0.21 - 0.73，P = 0.00），术中失血量[平均差（MD）=1.69，I² = 0.00%，95%CI = 1.15 - 2.47，P = 0.01]，PLOS（MD = -0.42，I² = 94.87%，95%CI = -0.86 - 0.03，P = 0.07），腹腔引流时间（MD = -1.23，I² = 96.96%，95%CI = -2.04至 -0.42，P = 0.00），以及再次入院率（OR = 0.44，I² = 0.00%，95%CI = 0.23 - 0.85，P = 0.01）。