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,2025,(11):1074-1080.[doi:10.3760/cma.j.cn101785-202311040-016]
加速康复外科在儿童胆总管囊肿围手术期应用效果的Meta分析
- Title:
- Effect of enhanced recovery after surgery in perioperative period of choledochal cyst in children:a Meta-analysis
- 摘要:
- 目的 通过Meta分析系统评价加速康复外科(Enhanced Recovery After Surgery,ERAS)在儿童胆总管囊肿围手术期的应用效果。方法 检索PubMed、Embase、Cochrane Library、Web of Science、中国知网(China National Knowledge Infrastructure,CNKI)、万方数据知识服务平台、维普资讯中文期刊服务平台、中国生物医学文献(China Biology Medicine,CBM)服务系统,收集建库至2023年9月收录的关于ERAS在胆总管囊肿患儿围手术期中应用的相关文献。研究指标包括ERAS干预措施、手术时间、术中出血量、术后首次肛门排气排便时间、术后首次饮水时间、术后并发症发生率、术后住院时间以及住院总费用。采用RevMan 5.3软件进行Meta分析。结果 最终纳入8篇队列研究,共543例患儿,按照围手术期措施不同分为 ERAS组、传统治疗组,其中ERAS组292例,传统治疗组251例。Meta分析结果显示, ERAS组患儿在术后首次肛门排气时间(WMD=-25.29,95%CI:-30.22~-20.36)、术后首次排便时间(WMD=-15.82,95%CI:-28.04~-3.59)、术后住院时间(WMD=-2.98,95%CI:-3.69~-2.27)、住院总费用(WMD=-0.81,95%CI:-1.00~-0.61)、术后总体并发症发生率(OR=0.50,95%CI:0.29~0.87)均优于传统治疗组,差异有统计学意义(P＜0.05);而在手术时间(WMD=-0.10,95%CI:-0.21~0.02)及术中出血量(WMD=-0.58,95%CI:-19.8~0.82)方面差异无统计学意义(P＞0.05)。结论 ERAS理念应用于儿童胆总管囊肿围手术期管理,可减轻患儿术后应激反应、减少术后并发症的发生、缩短住院时间、减少住院总费用的优点,有利于患儿术后快速康复。
- 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.
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备注/Memo
收稿日期:2023-11-27。
通讯作者:杨平,Email:127789667@qq.com