Meta-analysis Of The Application Of The Fast-track Surgeryconceptin The Liver Transplantation

Objective: It aims to evaluate the value and effectiveness of series of treatment measuresguided by the Fast-track surgery theory in liver transplantation and provide the basis for the optimization scheme of the liver transplantation during the peri operation period.Methods: Retrieve the literature database of Pub Med,Medlin,Embase,Wan Fang Med,CNKI Med,VIP Med from 2000 to December 2017 and the literature related to the application of the Fast-track surgery theory in the liver transplantation and officially published in magazines.The collected literaturesarescreened and the design method of the test is divided.Exclusion and inclusion criteria are also formulated.The randomized controlled trial and(RCT)and case-control study(CCT)will be included into the study while other literatures will be abandoned.Carry out the study according to the exclusion and inclusion criteria and exclude the literatureswhichdo not conform to the conditions.Theliteraturesbelonging to the case-control studyare evaluated by the literature quality evaluation scale of Newcastle-Ottawa Scale(NOS);Theliteraturesbelonging to therandomized controlled trialareevaluated by the quality evaluation standard of Cochrane RCT.Extract the data of the literature included by the study,such as authors,publication time,sample size,literature type,time of hospitalization,incidence of postoperative complications,incidence of hydrothorax and ascites andincidence of bad incisional healing,and formulate the standard of analysis and inspection.After the process mentioned above,it has retrieved 66 literaturesrelated to the study,including12 Chinese literatures and 6 English literatures.Finally,it has retrieved5 literature,including4 Chinese literatures and 1 English literature.Besides,one of them is CCTliterature and four of them are RCTliteratures.Carry out the statistics on the sample size of the literature included in the study.Totally 556 cases are included.302 cases belong to the FTS group while 254 cases belong to the NFTS group.The statistical analysis of the days of hospitalization,incidence of postoperative complications,incidence of postoperative hydrothorax and ascites,incidence of postoperativebad incisional healing is carried out with RevMan 5.3 software.Results: Finally,556 patients in 5 literatures are included.They are divided into the FTS group(n=302)and the NFTS group(n=254).The incidence of postoperative complications is statistically different between the FTS group and the NFTS group[P=0.0002,OR=0.36,95%CI:0.21~0.62].The incidence of postoperative hydrothorax and ascitesis statistically different between the FTS group and the NFTS group[OR=0.5,95%CI:0.25~1.00,P=0.05].The days of hospitalizationis statistically different between the FTS group and the NFTS group[MD=-6.58,95%CI:-9.60~-3.57,P<0.00001].The incidence of postoperative bad incisional healing isnot statistically different between the FTS group and the NFTS group[OR=0.76,95%CI:0.17~3.32,P=0.71].Conclusion: The application of the rapid rehabilitationconcept in the liver transplantation can reduce the time of hospitalization,the incidence of postoperative complications and the incidence of postoperative hydrothorax and ascites.However,the incidence of postoperative bad incisional healing of the FTS group is not better than the NFTS group.It is considered thatthe application of ERAS in the liver transplantation is safe,effective and available.It can realize the postoperative rapid rehabilitation of patients.