加速康复外科理念应用于腹腔镜膀胱癌根治术中临床疗效的meta分析-东南大学学报医学版

加速康复外科理念应用于腹腔镜膀胱癌根治术中临床疗效的meta分析

单位：南昌大学第一附属医院泌尿外科, 江西南昌 330000

分类号：R737.14

出版年·卷·期（页码）：2019·38·第四期（704-712）

摘要：

目的：系统评价加速康复外科理念在腹腔镜膀胱癌根治术中应用的有效性及安全性。方法：检索2001年1月至2018年10月关于腹腔镜膀胱癌患者围手术期行加速康复（ERAS）方案和常规康复（CRAS）方案治疗对比分析的相关文献，检索数据库包括PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、维普、万方数据库。由2名研究者独立进行文献筛选、资料提取和方法学质量评价，采用RevMan 5.3软件进行meta分析。结果：共纳入16篇文献，其中7篇为回顾性研究，9篇为随机对照研究，共计1 250例患者（ERAS组638例，CRAS组612例）。meta分析结果显示，平均手术时间ERAS组短于CRAS组（WMD=-1.96，95% CI为-3.23~-0.69，P<0.01）；术后住院时间ERAS组短于CRAS组（WMD=-4.68，95% CI为 -6.3~-3.06，P<0.01）；住院费用ERAS组少于CRAS组（WMD=-0.97，95% CI为-1.07~-0.88，P<0.01）；术后首次排气时间ERAS组早于CRAS组（WMD=-1.18，95% CI为-2.23~-0.13，P=0.03）；术后耐受经口进食时间ERAS组提前于CRAS组（WMD=-5.44，95% CI为-7.50~-3.37，P<0.01）；术后首次下床活动时间ERAS组早于CRAS组（WMD=-1.52，95% CI为-2.31~-0.91，P<0.01）；术后并发症发生率ERAS组低于CRAS组（OR=-0.31，95% CI为-0.22~-0.45，P<0.01）；两组在术中出血量、术后30 d返院率差异均无统计学意义（P>0.05）。结论：ERAS方案应用于腹腔镜膀胱癌根治术的围手术期是安全有效的，能缩短平均手术时间、术后住院时间、术后首次排气时间、术后首次下床活动时间等，且可降低患者住院费用及术后并发症发生率。

Objective: To systematically review the efficacy and safety of enhanced recovery after surgery in laparoscopic radical cystectomy. Methods: The controlled clinical studies which involved enhanced recovery after surgery and conventional recovery after surgery in PubMed, Embase, Cochrane Library, CNKI,VIP and Wangfang database were searched from January 2001 to October 2018. Two researchers independently filtered literature, extracted data and evaluated the methodological quality of research papers. The mate-analysis was performed using the RevMan 5.3 software. Results: A total of 16 articles were included, of which 7 were retrospective studies and 9 were randomized controlled studies with a total of 1 250 patients, of whom 638 were in ERAS group,612 were in CRAS group. Meta-analysis showed that the mean operative time of ERAS group was shorter than that of CRAS group (WMD=-1.96,95% CI-3.23, 0.69, P<0.01). The mean operative time of ERAS group was shorter than that of CRAS group (P<0.05). The postoperative hospitalization time was shorter in ERAS group than in CRAS group (WMD=-4.68,95% CI-6.3/3.06, P<0.01), and the hospitalization cost was less than that in CRAS group (WMD=-0.97,95% CI-1.07/0.88, P<0.01). The first time of exsufflation was earlier than that of CRAS group (WMD=-1.18,95% CI-2.23/0.13, P<0.05), and the postoperative oral intake time was earlier than that of CRAS group (WMD=-5.44,95% CI-7.50/3.37, P<0.01). The first time out of bed after operation was earlier in ERAS group than in CRAS group (WMD=-1.52,95% CI-2.31, 0.91, P<0.01), and the incidence of postoperative complications was lower than that in CRAS (OR=-0.31,95% CI-0.22 to 0.45, P<0.01). There was no significant difference between the two groups in the volume of bleeding during operation and the rate of rehospitalization 30 days after operation (P<0.05). Conclusion: ERAS regimen is safe and effective in the perioperative period of laparoscopic radical resection of bladder cancer. It can shorten the average operation time, postoperative hospitalization time, first exhaust time after operation, and the first time out of bed after operation, and so on. It also reduces the cost of hospitalization and the incidence of postoperative complications.

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