摘要
目的 系统评价加速康复外科理念对腹腔镜胃癌根治术后患者炎性应激及生活质量的影响。方法 检索2015年1月至2023年1月关于腹腔镜胃癌患者术后行加速康复外科理念方案（ERAS）和常规康复方案（CRAS）治疗对比分析的相关文献，检索数据库有PubMed、Embase、Cochrane Libarary、中国知网、维普及万方。2名研究者进行文献筛选、资料提取及质量评价，采用RevMan5.3软件进行Meta分析。结果 最终纳入8篇文献，总例数为538例。两组血清CRP水平比较，差异存在统计学意义（Z=48.58，P<0.00001）。两组血清IL-6水平比较，差异存在统计学意义（Z=15.31，P<0.00001）。两组血清IL-8水平比较，差异存在统计学意义（Z=86.03，P<0.00001）。两组血清IL-10水平比较，差异存在统计学意义（Z=10.89，P<0.00001）。两组生活质量比较，差异存在统计学意义（Z=21.20，P<0.00001）。结论 ERAS方案用于腹腔镜胃癌根治术后患者是安全有效的，能够明显减轻术后患者炎症应激反应，同时显著提高患者生活质量。
关键词： 加速康复外科理念；胃癌；腹腔镜胃癌根治术；炎性应激；生活质量；发表偏倚；Meta分析
Abstract
Objective To systematically evaluate the impact of the concept of accelerated rehabilitation surgery on inflammatory stress and quality of life in patients after laparoscopic radical gastric cancer surgery. Methods From January 2015 to January 2023, relevant literature on the comparative analysis of the accelerated rehabilitation surgery concept(ERAS)and conventional rehabilitation program(CRAS)treatment for patients with laparoscopic gastric cancer after surgery was searched. The search databases included PubMed, Embase, Cochrane Libarary, CNKI, and Uyghur Wanfang. Two researchers conducted literature screening, data extraction and quality evaluation, and used RevMan5.3 software for Meta analysis. Results Finally, 8 articles were included, and the total number of cases was 538.There was a statistically significant difference in serum CRP levels between the two groups(Z=48.58,P<0.00001).The comparison of serum IL-6 levels between the two groups was statistically significant(Z=15.31, P<0.00001).The comparison of serum IL-8 levels between the two groups was statistically significant(Z=86.03, P<0.00001).The serum IL-10 levels of the two groups were compared, and the difference was statistically significant(Z=10.89, P<0.00001).There was a statistically significant difference in the quality of life between the two groups(Z=21.20, P<0.00001). Conclusion The ERAS regimen is safe and effective for patients after laparoscopic radical gastric cancer surgery. It can significantly reduce the postoperative inflammatory stress response and significantly improve the quality of life of patients.
Key words： Accelerated rehabilitation surgery concept; Gastric cancer; Laparoscopic radical gastrectomy; Inflammatory stress; Quality of life; Publication bias; Meta analysis
参考文献 References
[1] 赵婷华.加速康复外科护理对腹腔镜胃癌根治术患者手术结局,术后康复及生活质量的影响[J].国际护理学杂志,2021,40(12):2229-2233.
[2] 赵松,鲁琪,史朝瑞.加速康复外科理念在腹腔镜胃癌根治术患者中的效果[J].中国肿瘤临床与康复,2019,26(04): 506-509.
[3] 张凯光,周小海,郝建朋,等.加速康复外科模式在腹腔镜胃癌根治术中的应用[J].中国临床新医学,2019,12(11): 11-14.
[4] 柏巍松,赵立志,唐纪全,等.加速康复外科应用于全腹腔镜下远端胃癌D2根治术的价值及对炎症因子的影响[J].肿瘤研究与临床,2019,31(12):818-822.
[5] 虞煜,张谋成,高楷峻,等.加速康复外科在完全腹腔镜胃癌根治术中的应用[J].中华普通外科杂志,2020,35(001): 21-25.
[6] Alresayes S, Deeb M A, Mokeem S A, et al. Influence of body fat in patients with dental implant rehabilitation treated with adjunctive photodynamic therapy[J]. Photodiagnosis Photodyn Ther, 2020,31:101831.
[7] 杨吉荣,张珂诚,崔建新,等.加速康复外科在3D腹腔镜辅助胃癌根治术中的应用研究[J].腹腔镜外科杂志,2020, 25(03):55-59.
[8] 罗德胜,徐宏涛,章平禄,等.腹腔镜胃癌根治术患者实施加速康复外科的临床疗效分析[J].重庆医学,2019,48(18): 3121-3125.
[9] Plas M,Wal-Huisman H,Haan J,et al.The influence of the inflammatory response to surgery on the postoperative course in elderly oncological patients[J].Eur J Surg Oncol, 2019,45(2):41.
[10] 洪亮,史良会,吴泽晖,等.加速康复外科理念下腹腔镜远端胃癌根治术不放置腹腔引流管的临床研究[J].腹腔镜外科杂志,2020,25(05):34-37.
[11] 夏越超.加速康复外科理念在腹腔镜胃癌根治术中的临床应用效果[J].中国医药指南,2020,18(013):168-169.
[12] 杨鹏远,兰海生,陆佳明,等.加速康复外科对腹腔镜胃癌根治术后病人营养状况的影响[D].右江民族医学院, 2019.
[13] 孙淑华.加速康复外科理念在腹腔镜胃癌根治术围术期护理中的应用观察[J].中国药物与临床,2020,20(21): 147-148.
[14] 程康文,王贵和,束宽山,等.加速康复外科在腹腔镜辅助胃癌根治术中的应用及其对患者术后恢复、营养及应激的影响[J].中国普通外科杂志,2019(10):1228-1236.
[15] 夏秋燕.加速康复外科干预对腹腔镜辅助胃癌根治术患者术后恢复及应激反应的影响[J].当代医学,2020,580 (29):81-83.