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胰十二指肠切除术后营养支持效果及安全性的Meta分析
Clinical effect and safety of nutritional support after pancreaticoduodenectomy: A Meta-analysis
文章发布日期:2018年05月07日  来源:  作者:张宝华, 杨亚, 龚建平  点击次数:397次  下载次数:47次

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【摘要】:目的评估各种不同术后营养方式(包括全肠外营养、早期口服营养、鼻空肠管早期肠内营养、胃造瘘管早期肠内营养及空肠造瘘管早期肠内营养)对胰十二指肠切除(PD)术后患者预后的影响。方法检索Pubmed、Embase、Cochrane Library中PD术后营养支持相关文献,检索时间为2007年-2017年。将文献中研究对象及样本量、术式及术后营养方式、住院时间、感染(包括术后肺部感染、切口感染)发生率、胰瘘(B/C级)发生率、胃排空障碍的发生率纳入采用汇总分析,并采用RevMan5.3软件对术后全肠外营养与鼻空肠管早期肠内营养情况进行Meta分析。结果最终纳入11篇文献,4篇文献行Meta分析。横向比较发现不同营养途径支持的患者的住院天数无明显规律,纵向比较发现不同研究相同营养给予方式下患者的住院天数差异较大。在并发症方面,胃造瘘组的胰瘘发生率明显高于其他组(P值均<0.01);空肠造瘘组的胃排空延迟障碍发生率均高于其他组(P值均<0.01)。全肠外营养感染发生率为27.17%,低于口服营养组之外的其他组(40.63%、46.58%、33.64%),但差异无统计学意义(P值均>005)。Meta分析结果显示,全肠外营养组与鼻空肠管早期肠内营养组在住院时间和胃排空延迟障碍、胰瘘、感染发生率方面的差异均无统计学意义(P值均>0.05)。结论PD术后营养策略无明显优劣之分,临床可根据实践经验和患者具体情况制订合理的术后营养支持方案。
【Abstract】:ObjectiveTo investigate the effect of different nutritional support methods (including total parenteral nutrition, early oral nutrition, early enteral nutrition via nasojejunal tube, early enteral nutrition via gastric fistula, and early enteral nutrition via jejunal fistula) on the prognosis of patients after pancreaticoduodenectomy (PD). MethodsPubMed, Embase, and The Cochrane Library were searched for articles on nutritional support after PD published from 2007 to 2017. A pooled analysis was performed for related data including sample size, research contents, study population, research roadmap and methods, length of hospital stay, and incidence rates of infection (including postoperative pulmonary infection and incision infection), pancreatic fistula (grade B/C), and delayed gastric emptying, and RevMan 5.3 software was used for the meta-analysis of total parenteral nutrition and early enteral nutrition via nasojejunal tube after PD. ResultsA total of 11 articles were included, and 4 were included in the meta-analysis. The horizontal comparison showed no significant difference in the length of hospital stay between the patients undergoing nutritional support via different pathways, while the vertical comparison showed a significant difference. As for complications, the gastric fistula group had a significantly higher incidence rate of pancreatic fistula than the other groups (all P<0.01), and the jejunal fistula group had a significantly higher incidence rate of delayed gastric emptying than the other groups (all P<0.01). The total parenteral nutrition group had an incidence rate of infection of 27.17%, which was lower than that in the other groups (40.63%、46.58%、3364%), but there was no statistical significance in the differences (all P>0.05). The meta-analysis showed no significant differences between the total parenteral nutrition group and the nasojejunal tube early enteral nutrition group in length of hospital stay, delayed gastric emptying, and incidence rates of pancreatic fistula and infection. ConclusionNutritional strategies after PD have similar clinical effects and safety, and a reasonable nutritional support regimen can be developed based on clinical practice and patients′ conditions.
【关键字】:胰十二指肠切除术; 营养支持; Meta分析
【Key words】:pancreaticoduodenectomy; nutritional support; Meta-analysis
【引证本文】:
ZHANG BH, YANG Y, GONG JP. Clinical effect and safety of nutritional support after pancreaticoduodenectomy: A Meta-analysis[J]. J Clin Hepatol, 2018, 34(6): 1231-1236. (in Chinese) 张宝华, 杨亚, 龚建平. 胰十二指肠切除术后营养支持效果及安全性的Meta分析[J]. 临床肝胆病杂志, 2018, 34(6): 1231-1236.

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