Electroacupuncture for postoperative recovery of gastrointestinal function in patients with gastrointestinal cancers: A systematic review and meta-analysis

电针促进胃肠道癌症患者术后胃肠功能恢复：一项系统评价和meta分析

Xue-er YAN(严雪儿)^a,b, Shu-sheng CUI(崔述生)^c, Yan-rui WANG(王燕睿)^a,b, Mao-yu DING(丁茂裕)^b,d, Yi-qing CAI (蔡祎晴)^e, Pak Hang LUK^f, Ji-ping ZHAO(赵吉平)^a, Chao YANG(杨超)^a, Jia-jia ZHANG(张佳佳)^a, Zi-chen WANG(王子辰)^a, Si-yan CHEN(陈思言)^a,b, Xiao-min ZANG(臧晓敏)^g, Yu-hui HUANG(黄钰惠)^a,b , Cheng TAN(谭程)^a,b

^a Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China（北京中医药大学东直门医院，北京 100700，中国）

^b Beijing University of Chinese Medicine, Beijing, 100029 China（北京中医药大学，北京 100029，中国）

^c Beijing Drum Tower Hospital of Traditional Chinese Medicine, Beijing, 100009 China（北京市鼓楼中医医院，北京 100009，中国）

^d Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China（首都医科大学北京中医医院，北京 100010，中国）

^e Centre for Evidence-Based Chinese Medicine of Beijing University of Chinese Medicine, Beijing 100029, China（北京中医药大学循证医学中心，北京 100029，中国）

^f Herbal Inn, 191 Regents Park Rd, N3 3PA London, United Kingdom（永乐· 荷泊颖，伦敦 N3 3PA，英国）

^gJinan Municipal Organ Hospital, Jinan 250001, China（山东省济南市机关医院，济南250001,中国）

Abstract

Objective: To evaluate the efficacy and safety of electroacupuncture (EA) for postoperative recovery in patients with gastrointestinal (GI) cancers.

Methods: We retrieved articles from PubMed, Embase, OVID, Cochrane Library, Web of Science, CINAHL, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang, and Technology Journal Database (VIP) from database inception to November 1 2024. Randomized controlled trials (RCTs) that examining the use of EA to improve GI function, reduce pain, and promote self-care ability after GI cancer surgery were included. Based on the type of control interventions, separate meta-analyses were conducted for EA vs postoperative nursing (PN) and EA vs sham acupuncture (SA). The primary outcomes were the time to first flatus (TFF) and the time to first defecation (TFD). The secondary outcomes included the time to recovery of bowel sounds (TRBS), the time to tolerance of liquid diet (TTLD), the time to tolerance of semiliquid diet (TTSD), the time to independent walking (TIW), the length of hospitalization (LH), and visual analog scale (VAS) immediate resting pain scores measured on the first, second and third postoperative days (POD 1-3). Results are reported as mean differences (MDs) with 95% confidence intervals (CIs). RevMan 5.3 was used for meta-analysis, StataSE 15.1 was used for sensitivity analyses and Egger’s tests. This study was registered on PROSPERO (CRD42022314754).

Results: A total of 19 RCTs involving 1902 participants were included, all of which were conducted in China between 2004 and 2023. When EA compared with PN, the meta-analysis showed EA significantly reduce TFF (n = 673, MD = -13.14, 95% CI = [-18.97 to -7.31], P < 0.00001), TFD (n = 598, MD = -19.86, 95% CI = [-27.83 to -11.89], P < 0.00001), TRBS (n = 216, MD = -12.44, 95% CI = [-15.00 to -9.87], P < 0.00001), TTLD (n = 268, MD = -18.14, 95% CI = [-24.98 to -11.29], P < 0.00001), TTSD (n = 141, MD = -20.44, 95% CI = [-33.84 to -7.04], P = 0.003), VAS on POD 1 (n = 299, MD = -0.52, 95% CI = [-0.92 to -0.11], P = 0.01), VAS on POD 2 (n = 256, MD = -0.91, 95% CI = [-1.23 to -0.60], P < 0.00001), VAS on POD 3 (n = 203, MD = -0.57, 95% CI = [-0.80 to -0.34], P < 0.00001), while no significantly decreasing in the LH (n = 322, MD = -1.16, 95% CI = [-2.56 to 0.24], P = 0.10). As EA compared with SA, EA could significantly reduce TFF (n = 782, MD = -15.78, 95% CI = [-24.96 to -6.60], P = 0.0008), TFD (n = 782, MD = -20.42, 95% CI = [-36.14 to -4.70], P = 0.01), LH (n = 782, MD = -1.37, 95% CI = [-2.69 to -0.05], P = 0.04), TIW (n = 743, MD = -0.33, 95% CI = [-0.62 to -0.04], P = 0.03).13 studies reported that EA reduced the incidence of postoperative complications, and 7 studies reported safety assessments of acupuncture-related adverse events, including hematoma, residual needling, sharp pain, pain, soreness or swelling after needle removal, with no serious adverse events.

Conclusion: EA can significantly promote the recovery of GI function, reduce postoperative pain and accelerate the improvement of self-care ability in patients undergoing surgery for GI cancers.

【摘要】

目的：本研究旨在评估电针对胃肠道癌症患者术后恢复的有效性和安全性。

方法：本研究从PubMed、Embase、OVID、Cochrane Library、Web of Science、CINAHL、SinoMed、VIP、CNKI和万方数据库中检索自建库至2024年11月1日的相关文章，纳入了评估电针恢复胃肠癌术后患者胃肠功能、缓解疼痛及加快自理能力恢复的随机对照试验，根据对照组干预方式不同，将电针对比常规护理与电针对比假针刺分别展开荟萃分析。主要疗效指标为术后首次排气时间、首次排便时间，次要疗效指标包括肠鸣音恢复时间、术后液体饮食耐受时间、术后半流质饮食耐受时间、首次独立行走时间，住院时间以及术后第1、2、3天当日测定的疼痛视觉类比量表静息痛即时评分。结果以均数差和95%置信区间作出报告。使用RevMan 5.3进行meta分析，StataSE 15.1进行敏感性分析与Egger检验检测发表偏倚。本研究已在PROSPERO注册，编号为CRD42022314754。

结果：共纳入19项RCTs，涉及1902名参与者。研究均在2004年至2023年间于中国进行。（1）与术后常规护理相比，电针缩短了TFF (n = 673, MD = -13.14, 95% CI = [-18.97 to -7.31], P < 0.00001), TFD (n = 598, MD = -19.86, 95% CI = [-27.83 to -11.89], P < 0.00001), TRBS (n = 216, MD = -12.44, 95% CI = [-15.00 to -9.87], P < 0.00001), TTLD (n = 268, MD = -18.14, 95% CI = [-24.98 to -11.29], P < 0.00001), TTSD (n = 141, MD = -20.44, 95% CI = [-33.84 to -7.04], P = 0.003)。电针降低了患者术后第1天VAS (n = 299, MD = -0.52, 95% CI = [-0.92 to -0.11], P = 0.01), 术后第2天VAS (n = 256, MD = -0.91, 95% CI = [-1.23 to -0.60], P < 0.00001), 术后第3天VAS (n = 203, MD = -0.57, 95% CI = [-0.80 to -0.34], P < 0.00001)。电针对LH无影响 (n = 322, MD = -1.16, 95% CI = [-2.56 to 0.24], P = 0.10)。（2）与假针刺相比，电针缩短了TFF (n = 782, MD = -15.78, 95% CI = [-24.96 to -6.60], P = 0.0008), TFD (n = 782, MD = -20.42, 95% CI = [-36.14 to -4.70], P = 0.01), LH (n = 782, MD = -1.37, 95% CI = [-2.69 to -0.05], P = 0.04), 及 TIW (n = 743, MD = -0.33, 95% CI = [-0.62 to -0.04], P = 0.03)。（3）13项研究报告了电针可降低术后并发症的发生，7项研究报告了电针相关的不良事件，包括针刺局部血肿、残留针刺感、针刺如皮肤时的剧烈疼痛，以及遗留酸胀感，无严重不良事件发生。

结论：电针能促进胃肠道癌症术后患者的胃肠道功能恢复，减轻术后疼痛并加速术后自理能力提升。