摘要
目的:探讨快速康复外科理念(Enhanced recovery after surgery,ERAS)在机器人辅助前列腺癌根治术(Robot-assisted radical prostatectomy,RARP)中应用的有效性和安全性。方法:计算机检索PubMed、EMbase、Web of Science、中国知网(CNKI)、维普、万方和中国生物医学文献数据库(CBM),搜集机器人辅助前列腺癌根治术中应用快速康复外科理念治疗的回顾性队列研究和随机对照试验(Randomized controlled trial,RCT),检索时限均为建库至2021年2月25日,使用RevMan 5.4软件进行Meta分析。结果:纳入6个RCT和5个回顾性研究,共包括1 418例患者,其中671例患者行ERAS方案,747例行常规护理。Meta分析结果显示,ERAS组具有更短的住院时间[MD=-3.49,95%CI(-4.36,-2.62),P<0.00001],更快的首次肠道排气[MD=-12.66,95%CI(-16.30,-9.03),P<0.00001],更早的下床活动时间[MD=-21.06,95%CI(-27.25,-14.87),P<0.00001]及更低的术后并发症发生率[MD=0.45,95%CI(0.32,0.65),P<0.00001]。而在手术时间[MD=-1.83,95%CI(-8.25,4.59),P=0.58]和术中出血[MD=-17.08,95%CI(-41.34,7.18),P=0.17]方面两组之间差异无统计学意义。结论:在机器人辅助前列腺癌根治术中,ERAS方案相比常规护理方案能使患者快速实现肠道功能恢复和更早下床,降低患者术后并发症发生率,最终使患者早日出院,从而使前列腺癌患者从中获益。受纳入研究数量及质量的限制,该结论仍需更多高质量研究予以验证。
Objective: To systematically evaluate of the effectiveness and safety of enhanced recovery after surgery concept(ERAS) in robot-assisted l radical prostatectomy(RARP). Methods: PubMed, EMbase, Web of Science, CNKI, VIP Database,Wanfang Database and China Biology Medicine disc(CBMdisc) were searched to collect randomized controlled trials(RCT) and retrospective cohort studies on the application of ERAS in RARP, and the search time interval was set from database foundation to February 25, 2021. All collected data was performed meta-analysis with RevMan 5.4 software. Results: 6 RCTs and 5 retrospective studies were included and 1418 patients were involved, of which 671 adopt ERAS and 747 received routine care. Meta-analysis results show that the ERAS group has shorter hospital stay[MD=-3.49, 95% CI(-4.36,-2.62), P<0.00001], faster first bowel exhaust[MD=-12.66, 95% CI(-16.30,-9.03), P<0.00001], earlier time to get out of bed[MD=-21.06, 95% CI(-27.25,-14.87), P<0.00001], lower incidence of postoperative complications[MD=0.45, 95% CI(0.32, 0.65), P<0.00001]. No statistical difference on operative time [MD=-1.83, 95% CI(-8.25, 4.59), P=0.58]and intraoperative bleeding[MD=-17.08, 95% CI(-41.34, 7.18), P=0.17]between the two groups. Conclusion: ERAS in robotic radical prostatectomy could accelerate recovery of patients, reduce incidence of postoperative complications, and shorten hospital stays. Due to the limitations of quantity and quality of included studies, this conclusion needs to be further verified by more high-quality studies.
作者
赵磊
罗玉红
尹新玮
付良印
周逢海
ZHAO Lei;LUO Yuhong;YIN Xinwei;FU Liangyin;ZHOU Fenghai(The First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730000,China;College of Nursing,Lanzhou University,Lanzhou 730000,China;Department of Urology,Gansu Provincial People’s Hospital,Lanzhou 730000,China)
基金
甘肃省重点研发计划(21YF5FA016)。
