在上腺外科手术中改善手术后恢复协议:系统性审查和元分析
Giulio Lelli1, Angelo Iossa1, Alessandra Micalizzi1
1Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.
手术后增强恢复 (ERAS) 协议显著减少了上腺切除术患者的停留时间,并发症和疼痛. 这些协议还可以加快恢复速度,而不会增加重大并发症,尽管成本节省尚未在统计学上显著.
科学领域:
- 手术创新 在外科创新.
- 在外科手术期间的医学.
- 基于证据的实践.
背景情况:
- 在许多外科领域已经建立了手术后增强恢复 (ERAS) 协议,但对上腺手术来说定义较少.
- 上腺切除术涉及显著的生理压力,使ERAS应用成为一个相关的研究领域.
研究的目的:
- 系统地审查和元分析ERAS协议对上腺切除术患者外科期结局的影响.
- 将ERAS协议与上腺外科手术中的传统护理进行比较.
主要方法:
- 在PubMed,Scopus,ScienceDirect和Cochrane图书馆的系统文献搜索,没有时间限制.
- 包括成人上腺切除术患者的RCT,前性队列和后性比较研究.
- 主要结局:术后停留时间,疼痛和并发症率;次要结局:功能和胃肠道恢复,成本. 使用随机效应模型的元分析.
主要成果:
- 与429名患者进行的6项研究表明,ERAS协议显著减少了术后停留时间,并发症和疼痛.
- ERAS途径导致更快的功能恢复 (早期动员,导管切除,胃肠道恢复),没有增加重大并发症.
- 虽然个别研究表明成本节约,但综合分析并未证实住院费用的统计显著降低.
结论:
- 上腺切除术中的ERAS协议改善了外科手术期间的结果,加快了恢复,并安全地降低了发病率.
- 目前的证据受到异质性和质量的限制;需要进一步进行高质量的前性研究.
- 建议制定针对上腺手术的标准化ERAS指南.
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