Ou Yangxu, Lin Dezhi, Ni Xixiu, Feng Chengzhi, Rong Jing, Gao Xiaoyu, Yu Yang, Liu Xinrui, Zhang Zhiyang, Xiao Wang, Tang Zili, Zhao Ling
Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Med (Lausanne). 2024 Dec 11;11:1464749. doi: 10.3389/fmed.2024.1464749. eCollection 2024.
This study aimed to evaluate and compare the efficacy and safety of different acupuncture and moxibustion techniques as adjunctive therapy in addressing Postoperative gastrointestinal dysfunction (PGD) associated with gastric cancer (GC).
Eight medical databases were comprehensively searched for relevant randomized controlled trials (RCTs) as of October 2024. A network meta-analysis (NMA) was performed using frequency models, combining all available direct and indirect evidence from RCTs. Time of first bowel sounds (TFBS) was set as the primary outcome, and time to first defecation (TFD) and time to first flatus (TFF) were set as the secondary outcomes. All outcomes were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to determine a hierarchy of treatments, and the probability that the intervention will be in one of the top ranks increases with a higher SUCRA value.
With 28 randomized controlled trials (RCTs) and 2,459 patients, 18 of which involved adjuvant acupuncture treatments. NMA based on SUCRA rankings showed that routine care (RC) with acupuncture (ACU), with acupressure (ACUP), with moxibustion (MOX) and acupoint injection (AI) were the top-ranked therapies for shortening TFBS and TFF in patients with GC compared with RC; additionally, RC + MOX + CUP and RC + MOX were the relatively best therapies for TFD. No serious adverse events were reported in the studies assessing the safety of adjunctive acupuncture therapy. Our study found that ST36, ST37, ST39, and PC6 were the most commonly used acupoints for adjuvant acupuncture treatments in treating PGD associated with GC.
Acupuncture and moxibustion, when used as supplementary therapies, demonstrated efficacy and relative safety in managing PGD associated with GC. The recommended order for adjunctive acupuncture- and moxibustion-related therapies for PGD in patients with GC, in terms of conservativeness, is as follows: RC + ACU, RC + MOX + AI, RC + ACUP, RC + MOX + CUP and RC + MOX. Despite their inclusion, the overall methodological quality of the studies was poor, which need for further high-quality randomized controlled trials to support existing results.
本研究旨在评估和比较不同针灸技术作为辅助疗法治疗胃癌（GC）相关术后胃肠功能障碍（PGD）的疗效和安全性。
全面检索了截至2024年10月的8个医学数据库，以查找相关随机对照试验（RCT）。使用频率模型进行网络荟萃分析（NMA），整合RCT中所有可用的直接和间接证据。首次肠鸣音时间（TFBS）被设定为主要结局，首次排便时间（TFD）和首次排气时间（TFF）被设定为次要结局。所有结局均使用累积排序曲线下面积（SUCRA）概率进行排序，以确定治疗等级，SUCRA值越高，干预措施处于较高等级之一的概率越大。
纳入28项随机对照试验（RCT），共2459例患者，其中18项涉及辅助针灸治疗。基于SUCRA排名的NMA显示，与常规护理（RC）相比，针灸（ACU）、指压（ACUP）、艾灸（MOX）和穴位注射（AI）联合RC是缩短GC患者TFBS和TFF的最佳治疗方法；此外，RC + MOX + CUP和RC + MOX是TFD相对最佳的治疗方法。在评估辅助针灸疗法安全性的研究中，未报告严重不良事件。我们的研究发现，ST36、ST37、ST39和PC6是辅助针灸治疗GC相关PGD最常用的穴位。
针灸作为辅助疗法，在治疗GC相关PGD方面显示出疗效和相对安全性。就保守性而言，GC患者PGD辅助针灸相关疗法的推荐顺序如下：RC + ACU、RC + MOX + AI、RC + ACUP、RC + MOX + CUP和RC + MOX。尽管纳入了这些研究，但研究的整体方法学质量较差，需要进一步开展高质量随机对照试验来支持现有结果。
