手术后加速康复（ERAS）指南的实施对深部浸润性子宫内膜异位症手术的影响：一项系统评价和荟萃分析。
Impact of Enhanced Recovery After Surgery (ERAS) guidelines implementation in deep infiltrating endometriosis surgery. A systematic review and meta-analysis.
作者信息
Douligeris Athanasios, Kathopoulis Nikolaos, Karasmani Christina, Kypriotis Konstantinos, Zacharakis Dimitrios, Mortaki Anastasia, Prodromidou Anastasia, Chatzipapas Ioannis K, Grigoriadis Themos, Protopapas Athanasios
机构信息
1st Department of Obstetrics and Gynecology, Endoscopic Surgery Unit, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
1st Department of Obstetrics and Gynecology, Urogynaecology Unit, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
出版信息
Facts Views Vis Obgyn. 2025 Mar 28;17(1):15-29. doi: 10.52054/FVVO.2024.13599.
BACKGROUND
The complexity of surgical management in women with deep infiltrating endometriosis (DIE) demands the optimisation of perioperative care protocols to ensure optimal postoperative outcomes.
OBJECTIVES
This meta-analysis evaluates the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols compared to conventional perioperative care in patients undergoing surgery for DIE.
METHODS
A systematic literature search was conducted in Medline, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases from inception till August 2024. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios (RR) and random-effects model. Quality assessment was performed using the Risk of Bias in Non-randomised Studies of Interventions and Risk of Bias tools.
MAIN OUTCOME MEASURES
Primary outcomes assessed were postoperative length of hospital stay and readmission rates. Secondary outcomes included Clavien-Dindo grade I-II and grade III or higher complication rates.
RESULTS
Four comparative studies were included, encompassing a total of 1,662 patients. ERAS protocols significantly reduced the mean length of hospital stay [MD: -2.88 days; 95% confidence interval (CI): -5.34 to -0.41; =0.02] without increasing readmission rates (RR: 1.13; 95% CI: 0.75-1.73; =0.55). No significant differences were observed in Clavien-Dindo grade I-II complications (RR: 0.75; 95% CI: 0.49-1.16; =0.20) or grade III or higher complications rates (RR: 0.60; 95% CI: 0.27-1.33; =0.21).
CONCLUSIONS
ERAS protocols appear to reduce the length of hospital stay without increasing complications or readmissions in DIE surgery. However, further large-scale randomised studies still needed to be conducted to confirm these findings.
WHAT IS NEW?: The application of ERAS protocols is associated with better postoperative outcomes in patients undergoing major surgeries for DIE.
背景
深部浸润型子宫内膜异位症（DIE）女性患者手术管理的复杂性要求优化围手术期护理方案，以确保最佳术后效果。
目的
本荟萃分析评估与传统围手术期护理相比，加速康复外科（ERAS）方案在接受DIE手术患者中的有效性。
方法
从数据库建立至2024年8月，在Medline、Scopus、谷歌学术、Cochrane CENTRAL和ClinicalTrials.gov数据库中进行系统文献检索。使用RevMan 5.4软件（哥本哈根：北欧Cochrane中心，Cochrane协作网，2020年）进行荟萃分析，采用平均差（MDs）、合并风险比（RR）和随机效应模型。使用干预非随机研究中的偏倚风险和偏倚风险工具进行质量评估。
主要观察指标
评估的主要结局为术后住院时间和再入院率。次要结局包括Clavien-Dindo I-II级和III级及以上并发症发生率。
结果
纳入四项比较研究，共1662例患者。ERAS方案显著缩短了平均住院时间[MD：-2.88天；95%置信区间（CI）：-5.34至-0.41；P = 0.02]，且未增加再入院率（RR：1.13；9五%CI：0.75 - 1.73；P = 0.55）。Clavien-Dindo I-II级并发症（RR：0.75；95%CI：0.49 - 1.16；P = 0.20）或III级及以上并发症发生率（RR：0.60；95%CI：0.27 - 1.33；P = 0.21）无显著差异。
结论
ERAS方案似乎可缩短DIE手术的住院时间，且不增加并发症或再入院率。然而，仍需进一步开展大规模随机研究以证实这些发现。
新进展是什么？：ERAS方案的应用与接受DIE大手术患者更好的术后结局相关。
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