中国实用外科杂志

中国实用外科杂志

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肠内免疫营养对胃肠道恶性肿瘤病人术后近期结局影响Meta分析

周志军，张常华，夏光概，向    臻，魏哲威，朱锦涛，何裕隆   

  1. 中山大学附属第一医院胃肠外科 中山大学胃癌诊治研究中心，广东广州510080
  • 出版日期:2015-01-01 发布日期:2014-12-31

  • Online:2015-01-01 Published:2014-12-31

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摘要：

目的    探讨肠内免疫营养干预对胃肠道恶性肿瘤病人术后近期结局的影响。 方法    检索PubMed、Cochrane等数据库1999-2014年英文发表的对比肠内免疫营养支持与标准饮食对胃肠道恶性肿瘤病人术后近期结局影响的随机对照研究。用Cochrane协作网提供的方法评价文献质量，用Revman5.2软件进行Meta分析。结果    检索到相关文献275篇，纳入14篇，纳入研究对象1793例。对于营养状况不良的病人，围手术期补充肠内免疫营养与标准饮食比较可以显著降低术后感染率（OR=0.51，95% CI:0.36~0.70，P＜0.001）、吻合口瘘发生率（OR=0.55，95% CI:0.33~0.91，P＜0.05）、总体并发症发生率（OR=0.47，95% CI:0.35~0.64，P＜0.001）和病死率（OR=0.33，95% CI:0.12~0.87，P＜0.05），且可以缩短住院天数（SMD=-0.52，95% CI：-0.75~-0.29，P＜0.001）。对于营养良好的病人，在术后感染率、吻合口瘘、总体并发症、病死率及术后住院天数方面，免疫营养与标准饮食无统计学差异。 结论    对于营养不良的胃肠道恶性肿瘤病人，围手术期肠内免疫营养干预可以改善术后近期结局。

关键词: 胃肠道, 恶性肿瘤, 肠内免疫营养, Meta分析

Abstract:

Effect of enteral immunonutrition on postoperative outcomes in patients with gastrointestinal malignancy: a Meta-analysis        ZHOU Zhi-jun, ZHANG Chang-hua, XIA Guang-gai, et al.Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Gastric Cancer Center of Sun Yat-sen University, Guangzhou510080, China
Corresponding author: ZHANG Chang-Hua, E-mail: zhchangh@mail.sysu.edu.cn
Abstract    Objective    To investigate effect of enteral immunonutrition（EIN）supplementation on postoperative outcomes in patients with gastrointestinal malignancy. Methods    Randomized clinical trials (RCT) published in English from 1999 to 2014, that compared the supplementation of enteral immunonutrition with standard nutrition on postoperative outcomes in patients with gastrointestinal malignancy were searched in PubMed, Cochrane and other databases. The quality of included literature was assessed by the risk of bias table provided on Cochrane Library. Statistical analysis was performed by Revman5.2 software. Results    Fourteen RCTs involving 1793 patients were included in the Meta-analysis. For those who were malnourished, perioperative supplementation of immunonutrition can significantly decrease the rate of postoperative infection（OR=0.51, 95% CI:0.36~0.70, P＜0.001）, anastomotic leakage（OR=0.55, 95% CI:0.33~0.91, P＜0.05）, morbidity（OR=0.47, 95% CI:0.35~0.64, P＜0.001）, mortality（OR=0.33, 95% CI:0.12~0.87, P＜0.05）, and the length of hospital stay（SMD=-0.52, 95% CI：-0.75~-0.29，P＜0.001） compared to standard nutrition supplementation. However, for those who were well nourished, the rate of postoperative infection, anastomotic leakage, morbidity and mortality, and length of hospital stay were similar between the two groups. Conclusion    Enteral immunonutrition supplementation can improve postoperative outcomes for malnourished patients with gastrointestinal malignancy.

Key words: gastrointestinal, neoplasms, enteral immunonutrtion, Meta-analysis