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肿瘤患者由于自身免疫功能低下，常常对手术的应激能力差，术前的机械性肠道准备会造成大量体液、电解质的丢失和营养素的摄入不足，进一步影响患者对手术的应激能力，增加术后并发症和患者的痛苦。目前有研究表明口服无渣肠内营养制剂可以达到术前机械性肠道准备的效果，同时弥补它带来的弊端。本研究为了系统性评价肠内营养在结直肠癌术前肠道准备的疗效和安全性，检索了有关肠内营养在结直肠癌术前肠道准备与结直肠癌术前机械性肠道准备疗效和安全性的对比性研究文献，进行Meta分析。该研究得出结论，肠内营养应用于结直肠癌患者术前肠道准备具有与术前机械性肠道准备相似的肠道清洁率，并且可以改善患者术后的营养状态，减少术后并发症。本文虽具有一定的启示作用，但还需要开展多中心、大样本、高质量的随机对照试验来验证。
1.肠内营养在结直肠癌患者术前肠道准备疗效和安全性的Meta分析
胡抢,杨汐茵,孙元水等.
中华临床营养杂志.2018.26(1):26-33.
摘要
目的：系统性评价肠内营养在结直肠癌术前肠道准备的疗效和安全性。
方法：检索建库至2017年3月中国知网(CNKI)、万方数据库、维普数据库(VIP)，PubMed、Coehrane library、Web of Science有关肠内营养在结直肠癌术前肠道准备与结直肠癌术前机械性肠道准备疗效和安全性的对比性研究文献。对两组患者术后淋巴细胞总数、前白蛋白、白蛋白、血红蛋白、转铁蛋白、并发症、肛门排气时间、肠道清洁率等数据进行Meta分析。数据分析使用RevMan 5.3软件。
结果：共12篇随机对照文献纳入本研究，总共617例患者纳入本次Meta分析，其中使用肠内营养作为结直肠癌术前肠道准备的有308例患者，使用机械性肠道准备作为结直肠癌术前肠道准备的有309例患者，结果显示肠内营养应用于结直肠癌患者术前肠道准备具有与术前机械性肠道准备相似的肠道清洁率(OR=1.54，95%CI=0.98~2.41，P=0.06)和肛门恢复排气时间(WMD=-8.14，95%CI=-18.25~2.07，P=0.12)，但可以提高患者术后淋巴细胞(WMD=0.19，95%CI=0.06~0.32，P<0.01)、前白蛋白(WMD=20.16，95%CI=15.77~20.54，P<0.01)、白蛋白(WMD=2.60，95%CI=1.69~3.51，P<0．01)、血红蛋白(WMD=7.18，95%CI=3.6l~10.75，P<0．01)、转铁蛋白(WMD=0.29，95%CI=0.12~0.47，P<0.01)的量，减少术后并发症发生率(OR=0.18，95%CI=0.11~0.28，P<0.01)。
结论：现有证据表明，肠内营养应用于结直肠癌术前肠道准备可以提高术后淋巴细胞、前白蛋白、白蛋白、血红蛋白、转铁蛋白，减少术后并发症的发生，值得在临床上推广使用。
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1.Efficacy and safety of enteral nutrition in preoperative bowel preparation for colorectal cancer：a meta-analysis
胡抢,杨汐茵,孙元水等.
中华临床营养杂志.2018.26(1):26-33.
Abstract
Objective:To systematically evaluate the efficacy and safety of enteral nutrition in preoperative bowel preparation for colorectal cancer．
Methods:We searched in multiple databases(i.e. CNKI, Wan fang Data, VIP, PubMed，Coehrane Library, and Web of Science)for studies up to March 2017 that compared the efficacy and safety of enteral nutrition vs. mechanical bowel preparation before surgical treatment of colorectal cancer．Meta—analysis was conducted with RevMan 5.3 to compare the two approaches in terms of postoperative lymphocyte count, complications, anal exhaust time, intestinal cleaning rate, and levels of prealbumin, albumin, hemoglobin, and transferrin．
Results:A total of 12 randomized controlled trials involving 617 patients were included in this study, where 308 patients received enteral nutrition and 309 had mechanical bowel preparation.The results showed that enteral nutrition was comparable to mechanical bowel preparation in bowel cleaning rate(OR=1.54, 95%CI=0.98~2.41, P=0.06)and anal exhaust time(WMD=-8.14, 95%CI=-18.25~2.07, P=0.12), and it could lead to higher levels of lymphocytes(WMD=0.19,95%CI=0.06~0.32,P<0.01),prealbumin(WMD=20.16,95%CI=15.77~20.54, P<0.01)，albumin(WMD=2.60, 95%CI=1.69~3.51, P<0.01), hemoglobin(WMD=7.18, 95%CI=3.61~10.75, P<0.01)，and transferrin (WMD=0.29, 95%CI=0.12~0.47, P<0.01), and reduce the incidence of postoperative complications(OR=0.18, 95%CI=0.11~0.28, P<0.01)．
Conclusions:Current evidence showed that using enteral nutrition for bowel preparation before surgical treatment of coloreetal cancer could improve postoperative profiles of lymphocyte count, prealbumin, albumin, hemoglobin, and transferrin, and reduce complications. This approach should be adopted in the clinic．
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