Liu Ming,Gou Yunpeng,Xu Dong,et al.Effect of enhanced recovery after surgery in perioperative period of choledochal cyst in children:a Meta-analysis[J].Journal of Clinical Pediatric Surgery,,():1074-1080.[doi:10.3760/cma.j.cn101785-202311040-016]
Effect of enhanced recovery after surgery in perioperative period of choledochal cyst in children:a Meta-analysis
- Abstract:
- Objective To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in children with choledochal cyst by Meta-analysis. Methods The databases of PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure (CNKI),WANFANG DATA,VIP Journal Integration Platform and China Biology Medicine (CBM) Service System were searched by computer.The relevant literature items on perioperative applications of accelerated rehabilitation surgery in children with choledochal cyst were retrieved until September 2023.The English search terms included enhanced recovery after surgery,ERAS,fast track surgery,FTS,choledochal cysts,congenital biliary dilatation,common bile duct cyst,children,child and infant,etc.And the Chinese search terms included accelerated rehabilitation,rapid rehabilitation,choledochal cyst,congenital bile duct dilatation,child,children and infants.Meta-analysis was performed with RevMan 5.3 software. Results Finally 8 cohort studies were included with a total of 543 children.According to different perioperative measures,they were assigned into two groups of ERAS (n=292) and traditional treatment (n=251).The results of Meta-analysis revealed that time of initial anal exhaust (WMD=-25.29,95%CI:-30.22-20.36,P<0.00001) and time of initial postoperative defecation (WMD=-15.82,95%CI:-28.04~-3.59,P<0.05),postoperative hospitalization stay (WMD=-2.98,95%CI:-3.69~-2.27,P<0.00001),total hospitalization expense (WMD=-0.81,95%CI:-1.00~-0.61,P<0.00001) and the incidence of postoperative complications (OR=0.50,95%CI:0.29-0.87,P<0.05) were better in ERAS group than those in traditional treatment group.And the differences were statistically significant.No significant inter-group differences existed in operative duration (WMD=-0.10,95%CI:-0.21~0.02,P>0.05) or intraoperative volume of blood loss (WMD=-0.58,95%CI:-19.8~0.82,P>0.05). Conclusions Applying ERAS concept to perioperative managements of choledochal cysts in children may alleviate postoperative stress responses,minimize postoperative complications,shorten hospitalization stay and lower total hospitalization expense.It is also conducive to rapid postoperative recovery.
References:
[1] Lee HK, Park SJ, Yi BH, et al.Imaging features of adult choledochal cysts:a pictorial review[J]. Korean J Radiol, 2009, 10(1): 71-80. DOI: 10.3348/kjr.2009.10.1.71.
[2] Huang CS, Huang CC, Chen DF.Choledochal cysts:differences between pediatric and adult patients[J]. J Gastrointest Surg, 2010, 14(7): 1105-1110. DOI: 10.1007/s11605-010-1209-8.
[3] Ten Hove A, de Meijer VE, Hulscher JBF, et al.Meta-analysis of risk of developing malignancy in congenital choledochal malformation[J]. Br J Surg, 2018, 105(5): 482-490. DOI: 10.1002/bjs.10798.
[4] Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617. DOI: 10.1093/bja/78.5.606.
[5] Zhang B, Fang YF, Wu DM, et al.Efficacy analysis of enhanced recovery after surgery in laparoscopic-assisted radical resection of type I choledochal cyst[J]. Front Pediatr, 2023, 11:1191065. DOI: 10.3389/fped.2023.1191065.
[6] Tan YP, Shen YY, Li L, et al.Protocol for enhanced recovery after surgery with 3D laparoscopic excision for choledochal cysts can benefit the recovery process[J]. Pediatr Surg Int, 2020, 36(5): 643-648. DOI: 10.1007/s00383-020-04644-w.
[7] 姬响华, 耿宪杰, 李华冰.加速康复外科理念下路径式多元化健康教育在腹腔镜胆总管囊肿术患儿中的应用效果[J]. 河南医学研究, 2022, 31(16): 3052-3055. DOI: 10.3969/j.issn.1004-437X.2022.16.049. Ji XH, Geng XJ, Li HB.Effect of path-based pluralistic health education under enhanced recovery after surgery concept in children undergoing laparoscopic choledochal cyst[J]. Henan Med Res, 2022, 31(16): 3052-3055. DOI: 10.3969/j.issn.1004-437X.2022.16.049.
[8] 吕小逢, 唐杰, 徐小群, 等.加速康复外科在婴儿胆管扩张症围手术期的应用[J]. 中华小儿外科杂志, 2018, 39(11): 851-856. DOI: 10.3760/cma.j.issn.0253-3006.2018.11.011. Lyu XF, Tang J, Xu XQ, et al.Application of enhanced recovery after surgery in perioperative management of congenital cholangiectasis in infants[J]. Chin J Pediatr Surg, 2018, 39(11): 851-856. DOI: 10.3760/cma.j.issn.0253-3006.2018.11.011.
[9] 张现伟, 贾英萍, 张飞, 等.加速康复外科在Ⅰ型小儿胆管扩张症围手术期治疗中的应用[J]. 中华肝胆外科杂志, 2019, 25(8): 582-586. DOI: 10.3760/cma.j.issn.1007-8118.2019.08.006. Zhang XW, Jia YP, Zhang F, et al.Application of enhanced recovery after surgery in perioperative treatment of type Ⅰ biliary dilatation in children[J]. Chin J Hepatobiliary Surg, 2019, 25(8): 582-586. DOI: 10.3760/cma.j.issn.1007-8118.2019.08.006.
[10] 高如月.加速康复外科理念在小儿胆总管囊肿围手术期中的应用研究.郑州:郑州大学, 2020. Gao RY.Application of enhanced recovery after surgery in pediatric congenital choledochal cyst.Zhengzhou:Zhengzhou University, 2020.
[11] 郭志恒, 苏璠, 贾培丽, 等.加速康复外科理念下手术治疗先天性胆总管囊肿疗效观察[J]. 中华实用诊断与治疗杂志, 2022, 36(4): 377-379. DOI: 10.13507/j.issn.1674-3474.2022.04.013. Guo ZH, Su F, Jia PL, et al.Enhanced recovery after surgery concept in congenital choledochal cyst surgery[J]. J Chin Pract Diagn Ther, 2022, 36(4): 377-379. DOI: 10.13507/j.issn.1674-3474.2022.04.013.
[12] 王文儿, 周国超, 陈晓明, 等.ERAS在小儿先天性胆总管囊肿腹腔镜手术治疗中的应用[J]. 中国现代手术学杂志, 2020, 24(1): 15-19. DOI: 10.16260/j.cnki.1009-2188.2020.01.005. Wang WE, Zhou GC, Chen XM, et al.Clinical application of ERAS in the laparoscopy for congenital choledochus cyst in children[J]. Chin J Mod Oper Surg, 2020, 24(1): 15-19. DOI: 10.16260/j.cnki.1009-2188.2020.01.005.
[13] 李春燕, 黄萍, 胡恩慧, 等.加速康复外科在先天性巨结肠患儿围手术期应用效果的Meta分析[J]. 中华小儿外科杂志, 2023, 44(1): 43-50. DOI: 10.3760/cma.j.cn421158-20220309-00153. Li CY, Huang P, Hu EH, et al.Effect of enhanced recovery after surgery inperioperative period of children with Hirschsprung disease:a Meta-analysis[J]. Chin J Pediatr Surg, 2023, 44(1): 43-50. DOI: 10.3760/cma.j.cn421158-20220309-00153.
Memo
收稿日期:2023-11-27。
通讯作者:杨平,Email:127789667@qq.com