Cai Meixiang, Yang Bo, Zheng Yaping, Ding Lei
Department of Nursing, Changzhou Maternal and Child Health Care Hospital, Changzhou, China.
Department of Urology and Hepatobiliary Surgery, Changzhou Maternal and Child Health Care Hospital, Changzhou, China.
Balkan Med J. 2025 Jan 2;42(1):14-26. doi: 10.4274/balkanmedj.galenos.2024.2024-10-65.
Postoperative nutritional support in gastrointestinal cancer, including enteral nutrition (EN), parenteral nutrition (PN), and combined nutrition strategies, is vital for enhancing recovery and patient outcomes.
We aimed to comprehensively evaluate the impact of postoperative EN, PN, and EN + PN in patients with gastrointestinal cancer.
PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP were searched from conception until January 2, 2024. Randomized controlled trials (RCTs) that compared different postoperative nutritional support (EN, PN, or EN + PN) in patients with gastrointestinal cancer were included. The Cochrane Risk of Bias Assessment tool was used to assess the quality of the RCTs. Fixed- and random-effects models were chosen according to the heterogeneity of variables for the synthesis of results. Continuous and categorical variables were analyzed using the weighted mean difference or relative risk (RR) and 95% confidence interval (CI).
In this meta-analysis, 11 RCTs were included. The PN + EN group exhibited significantly improved postoperative recovery, nutritional function, and immune indicators than the PN and EN groups ( < 0.05). Additionally, a higher incidence of postoperative complications such as abdominal distension (RR: 2.53; 95% CI: 1.17-5.49), nausea/vomiting (RR: 2.01; 95% CI: 1.09-3.71), and diarrhea (RR: 3.17; 95% CI: 1.41-7.10) was observed in the EN group than in the PN + EN group.
Combining supplemental PN with enteral support improves energy intake and prognosis in gastrointestinal cancer, though limited studies restrict publication bias evaluation.
胃肠道癌术后的营养支持，包括肠内营养（EN）、肠外营养（PN）以及联合营养策略，对于促进康复和改善患者预后至关重要。
我们旨在全面评估术后EN、PN以及EN+PN对胃肠道癌患者的影响。
检索了从建库至2024年1月2日的PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、万方和维普。纳入比较胃肠道癌患者不同术后营养支持（EN、PN或EN+PN）的随机对照试验（RCT）。采用Cochrane偏倚风险评估工具评估RCT的质量。根据变量的异质性选择固定效应模型和随机效应模型进行结果合并。使用加权平均差或相对风险（RR）及95%置信区间（CI）分析连续变量和分类变量。
本荟萃分析纳入了11项RCT。PN+EN组术后恢复、营养功能和免疫指标的改善程度显著高于PN组和EN组（P<0.05）。此外，EN组术后腹胀（RR：2.53；95%CI：1.17 - 5.49）、恶心/呕吐（RR：2.01；95%CI：1.09 - 3.71）和腹泻（RR：3.17；95%CI：1.41 - 7.10）等并发症的发生率高于PN+EN组。
尽管有限的研究限制了对发表偏倚的评估，但补充PN与肠内支持相结合可改善胃肠道癌患者的能量摄入和预后。
