胃手术后胃肠减压的研究

将１６０例择期胃手术病人随机分二组。Ｉ组为术后不插胃管组，Ⅱ组为术后插管胃肠减压组。结果表明两组病人术后肠功能恢复时间相近（Ｐ＞０．０５），无吻合口漏、急性胃扩张等并发症，－Ⅱ组病人肺部感染明显增多（Ｐ＜０．０５），且插胃管后病人均感鼻咽部不适、恶心、术后早期不便下床活动等缺点。因此我们认为，择期胃手术后无须常规行胃肠减压，安全可靠。     

胆道术后镇痛对病人胃肠动力的影响研究

目的　探讨胆道术后镇痛对病人胃肠动力的影响。方法　选择 2 0 0 1年 1月～ 2 0 0 2年 7月胆道手术病人 2 18例 ,分为镇痛组 (A组 )和非镇痛组 (B组 ) ,统计两组病人术后胃瘫发生率、肛门排气时间、恢复进食时间、胃肠减压管留置时间长短。结果　①A组病人术后胃瘫发生率为 5 .0 % ,B组 0 .8% ,两组间差异无统计学意义。②A组病人术后肛门排气、恢复进食时间较B组显著延长 ,超过 3d病例数为 3 8例 ,B组 18例 ,P <0 .0 1。③A组病人术后胃肠减压管留置时间较B组延长 ,超过 3d病例数为 16例 ,B组 11例 ,P <0 .0 1,差异有显著性。结论　术后镇痛能有效地改善疼痛 ,但会导致胃肠功能恢复的延迟 ;对老年病人 (≥ 60岁 ) ,更会导致胃瘫的发生 ,所以在病人的选择方面应慎重。     

肝移植病人围手术期营养支持治疗

目的 总结肝移植病人围手术期营养支持治疗的经验。 方法 回顾性分析并对比广州军区广州总医院肝胆外科2003年8月至2006年12月（A组）和2007年1月至2010年3月（B组）两个阶段共205例肝移植病人临床资料、营养支持方法及有关指标。 结果 B组术前重度营养不良率为28.2%,显著高于A组（18.9%）;B组围手术期注重营养支持并辅以大黄鼻饲、灌肠以及吴茱萸散（自制）外敷脐部,术后肛门排气排便中位时间1.5d、感染并发症发生率32.82%;A组未注重营养支持,术后肛门排气排便中位时间3.5d、感染并发症发生率51.35%。两组差异有统计学意义。 结论 肝移植围手术期加强营养支持,辅以改善胃肠功能的方法可以提高肝移植病人耐受性、促进胃肠蠕动功能恢复、降低术后感染并发症发生率。     

肝叶切除术后患者胃肠减压停止时间的探讨

目的 探讨肝叶切除术后胃管拔除时机，为择期非胃肠道手术术后留置胃管的护理提供理论依据。方法 将78例肝叶切除术后患者随机分为观察组（40例）和对照组（38例），分别于术后12h和肛门排气后拔除胃管，观察两组患者术后腹部胀痛、恶心、进食时间、舒适度等指标。结果 两组术后腹部胀痛、恶心发生率比较，差异无显著性意义（均P〉0．05）；进食及肛门排气时间、肺不张、舒适度比较，观察组显著优于对照组（均P〈0．01）。结论 肝叶切除手术后尽早终止胃肠减压，可提高患者舒适度，促进患者术后康复。     

食管癌微创手术后不放胃管不禁食的可行性研究

目的：探讨食管癌微创术后不进行胃肠减压并早期进食的可行性。方法前瞻性纳入2013年1月至2014年1月间在河南省肿瘤医院胸外科行微创手术治疗、且术后不放胃管不禁食（不常规留置胃肠减压管,术后第1天开始进食）的156例的食管癌患者（早期进食组）。并选取2012年1-12月间行微创手术治疗但接受传统围手术期处理（常规放置胃肠减压管及鼻肠营养管,术后第7天开始经口进食）的160例食管癌患者作为对照（晚期进食组）。结果早期进食组中有6例（3．8％）患者由于术后并发症未能按计划进行早期进食。早期进食组患者较晚期进食组术后排气时间[（2．1±0．9） d比（3．3±1．1） d,P＜0．01]、术后排粪时间[（4．4±1．3） d比（6．6±1．0） d,P＜0．01）及术后住院时间[（8．3±3．2） d比（10．4±3．6） d,P＜0．01]均显著缩短,但两组术后并发症发生率的差异无统计学意义[19．2％（30/156）比25．0％（40/160）,P＞0．05]。多因素分析显示,早期经口进食是术后住院时间的独立影响因素（P＜0．01）,但并不是术后并发症发生的独立危险因素（P＞0．05）。结论食管癌微创手术后不放置胃肠减压管以及早期进食是安全可行的,可以加快术后患者胃肠功能恢复,缩短术后住院时间,而且并不增加术后并发症发生率。     

老年胃癌术后应用肠内营养管胃肠减压的临床研究

目的:探讨老年胃癌患者术后应用肠内营养管胃肠减压的安全性及有效性。方法:选择2007年2月—2010年2月在吉林省肿瘤医院手术治疗的老年胃癌患者66例,随机分为观察组(34例)和对照组(32例),观察组术后应用肠内营养管(复尔凯鼻胃管)胃肠减压,对照组用普通胃管(F16)胃肠减压。观察两组胃管的通畅性,咽喉疼痛,恶心、呕吐,肺部感染,吻合口瘘,切口感染或裂开等不良反应和并发症。结果:观察组和对照组胃管通畅率分别为94.11%和97%(P>0.05);观察组不良反应的发生率(咽喉疼痛8.84%;恶心、呕吐5.88%)低于对照组(咽喉疼痛28.13%;恶心、呕吐25.00%),差异均有统计学意义(均P<0.05);两组间并发症发生率的差异无统计学意义(均P>0.05)。结论:老年胃癌患者术后应用肠内营养管胃肠减压可达到胃管减压的相同效果,且不良反应少,利于患者术后康复。     

不常规经鼻胃肠减压在食管癌腔镜手术中应用的可行性研究

目的探讨不常规经鼻胃肠减压在食管癌腔镜手术中应用的可行性。方法分析2013年1~9月郑州大学附属肿瘤医院78例食管癌[无管组,男48例、女30例,年龄（61.1±8.5）岁]行食管癌腔镜手术前后均不留置鼻胃管患者的临床资料,选取2012年78例手术前后常规留置胃管7 d的食管癌患者[置管组,男50例、女28例,年龄（60.3±7.0）岁]作为对照。对两组患者的手术时间、术后并发症、术后胃肠道功能恢复情况及患者不适度等资料进行比较。结果两组患者均无住院死亡,无管组与置管组比较,肺部感染发生率（16.7%vs.19.2%,P=0.676）、吻合口瘘发生率（1.3%vs.2.6%,P=0.560）、胃管重置率（3.8%vs.2.6%,P=0.649）差异均无统计学意义;但无管组术后肠鸣音恢复时间[（2.5±1.1）d vs.（4.3±1.2）d,P〈0.05]、排气时间[（3.6±1.7）d vs.（5.8±2.1）d,P〈0.05]明显短于置管组;并且有97%（76/78）的置管组患者出现口干、咽喉肿痛等不适,无管组患者中只有6%（5/78）出现恶心症状。两组患者均随访至术后3个月,随访期间未出现肠梗阻、肺部感染及迟发性吻合口瘘等并发症。结论食管癌腔镜手术不常规留置胃肠减压管是安全、可行的,可减少患者的不适,加速胃肠道功能早期恢复。     

肝叶切除术后患者胃肠减压停止时间的探讨

目的探讨肝叶切除术后胃管拔除时机,为择期非胃肠道手术术后留置胃管的护理提供理论依据.方法将78例肝叶切除术后患者随机分为观察组(40例)和对照组(38例),分别于术后12 h和肛门排气后拔除胃管,观察两组患者术后腹部胀痛、恶心、进食时间、舒适度等指标.结果两组术后腹部胀痛、恶心发生率比较,差异无显著性意义(均P＞0.05);进食及肛门排气时间、肺不张、舒适度比较,观察组显著优于对照组(均P＜0.01).结论肝叶切除手术后尽早终止胃肠减压,可提高患者舒适度,促进患者术后康复.     

胰十二指肠切除术后不留置鼻胃及鼻肠营养管可行性研究

目的 探讨在胰十二指肠切除术后不留置鼻胃和鼻肠营养管的安全性及可行性。方法 回顾性分析2014年1月至2019年12月上海交通大学医学院附属新华医院普外科收治的238例胰十二指肠切除术病人的临床资料，其中110例不留置鼻胃及鼻肠营养管（未留置组），128例留置鼻胃及鼻肠营养管（留置组）。对比分析两组病人术后恢复情况、营养状况及术后并发症。结果 未留置组与留置组病人的手术时间、术中出血量、术后首次肛门排气和排便时间差异均无统计学意义（P>0.05），但未留置组病人术后住院时间更短，住院费用明显降低，差异有统计学意义（P<0.01）。未留置组病人在消化道不适症状（咽喉疼痛、恶心呕吐）、肺部感染方面明显优于留置组（P<0.05），且未增加胰瘘、胆瘘、切口感染、胃排空延迟、术后出血、腹腔感染的发生率（P>0.05）；两组在术后30 d死亡及二次手术方面差异无统计学意义（P>0.05）。术后第3、5天未留置组病人血红蛋白（Hb）、白蛋白（ALB）、前白蛋白（PAB）水平明显高于留置组，差异有统计学意义（P<0.01）。结论 胰十二指肠切除术后病人不常规放置鼻胃及鼻肠营养管安全可行，有利于病人的术后康复，减轻痛苦，改善术后营养状况。     

快速康复外科在腹腔镜小儿急性阑尾炎治疗中的应用

目的探讨快速康复外科(FTS)在腹腔镜小儿急性阑尾炎治疗中的应用效果。方法选取郑州市儿童医院普外科2013-12—2016-12间收治的120例急性阑尾炎患儿(年龄3~10岁)。将2013-12—2015-05间的60例作为对照组,行常规腹腔镜治疗;将2015-06—2016-12间的60例作为观察组,采用FTS腹腔镜治疗。比较2组术后上呼吸道感染、恶心呕吐、咽喉疼痛、肛门首次排气时间、切口感染、肠梗阻、住院时间及住院费用等情况。结果与对照组比较,观察组咽喉疼痛、恶心呕吐、尿道疼痛、术后肛门首次排气时间、住院时间、住院费用、粘连性肠梗阻发生率低于对照组,差异有统计学意义(P0.05)。2组术后上呼吸道感染、切口感染差异无统计学意义(P0.05)。结论在小儿急性阑尾炎腹腔镜治疗中应用FTS,可有效促进术胃肠道功能的恢复,减少并发症发生率,缩短住院时间,效果满意。     

θ���������в���������θ����ѹ�ܲ����ڽ�ʳ���ٴ�Ӧ���о�

??None routine nasogastric decompression tube and early oral feeding in abdominal surgery WANG Jian-zhong*??JIANG Zhi-wei??BAO Yang,et al. *No.2 Department of General Surgery, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China Corresponding author: JIANG Zhi-wei, E-mail: surgery34@163.com Abstract Objective To investigate the security and feasibility with none routine nasogastric decompression tube and early oral feeding in abdominal fast track surgery. Methods 62 patients who accepted gastrointestinal operation were inserted nasogastric decompression tube as control group(A group), meanwhile other 58 with none routine nasogastric decompression tube and early oral feeding according fast track surgery rules as the experiment group(B group). We compared their time to flatus and the ratio of postoperative complications including throat ache, nausea, atelectasis, wound infection, pneumonia, anastomotic leak. Results To compared A group the time to flatus was advanced in B group(P??0.05). While the ratio of throat ache and nausea in A group increased significantly(P??0.01). And other postoperative complications were no difference between two groups. There were few patients need to reinsertion of nasogastric decompression tube because of atelectasis in two groups but no significantly difference(P??0.05). Conclusion None routine nasogastric decompression tube and early oral feeding in abdominal fast track surgery was safe and feasibility.     

A prospective randomized trial of routine postoperative nasogastric decompression in patients with bowel anastomosis.

Until relatively recently, the nasogastric (NG) tube has been used routinely for decompression in the patient with small- or large-bowel anastomosis. To determine if routine postoperative NG decompression benefited such patients, 102 patients were randomized prospectively to either NG decompression or no-NG tube. Excluded were patients with chronic bowel obstruction, peritonitis, gross fecal contamination or spillage, and previous abdominal or pelvic irradiation. There were 52 patients in the no-NG group and 50 in the NG group. Patients in the no-NG group had earlier bowel sounds, return of flatus, oral intake and first bowel movement. Four patients (8%) in the no-NG group, compared with one patient (2%) in the NG group, required subsequent decompression. Length of hospital stay was significantly (p < 0.001) shorter in the no-NG group. There were no significant differences in the presence of atelectasis, postoperative fever, wound infections and anastomotic leaks between the two groups. The authors conclude that routine nasogastric decompression is not warranted after elective surgery involving small- or large-bowel anastomosis.     

Is Nasogastric or Nasojejunal Decompression Necessary after Gastrectomy? A Prospective Randomized Trial

BACKGROUND: Nasogastric decompression has been routinely used in most major abdominal operations to prevent the consequences of postoperative ileus. The aim of the present study was to assess the necessity for routine prophylactic nasogastric or nasojejunal decompression after gastrectomy. METHODS: A prospective randomized trial included 84 patients undergoing elective partial or total gastrectomy. The patients were randomized to a group with a postoperative nasogastric or nasojejunal tube (Tube Group, n = 43) or to a group without a tube (No-tube Group, n = 41). Gastrointestinal function, postoperative course, and complications were assessed. RESULTS: No significant differences in postoperative mortality or morbidity, especially fistula or intra-abdominal sepsis, were observed between the groups. Passage of flatus (P < 0.01) and start of oral intake (P < 0.01) were significantly delayed in the Tube Group. Duration of postoperative perfusion (P = 0.02) and length of hospital stay (P = 0.03) were also significantly longer in the Tube Group. Rates of nausea and vomiting were similar in the two groups. Moderate to severe discomfort caused by the tube was observed in 72% of patients in the Tube Group. Insertion of a nasogastric or nasojejunal tube was necessary in 5 patients in the No-tube Group (12%). CONCLUSIONS: Routine prophylactic postoperative nasogastric decompression is unnecessary after elective gastrectomy.     

鼻肠管减压及奥曲肽治疗术后早期炎症性肠梗阻的临床研究

目的 评价、比较鼻肠减压导管以及奥曲肽,在腹部手术后早期炎症性肠梗阻保守治疗中的作用.方法 2005年3月至2009年1月期间45例腹部手术后早期炎症性肠梗阻的患者,使用鼻胃管减压等常规保守治疗无效后,非随机分为肠减压导管治疗组(23例)以及奥曲肽治疗组(22例),比较两种治疗方法与常规保守治疗方法以及两种治疗方法之间的疗效差别.结果 经鼻胃管减压的常规保守治疗无效的45例患者,经过上述两种治疗方法的保守治疗,3-12 d所有患者的肠梗阻均得以缓解;与奥曲肽治疗组相比,肠减压导管治疗组的自主排气时间更短[(4.7±1.9)d比(6.7 ±1.6)d]、腹围恢复得更快[(90.4±2.0)%比(95.1±1.3)%],但累计胃肠减压量[(4037±1155)ml比(3316±1038)m1]及日均胃肠减压量[(890±181)ml比(492±83)ml均更多,两组差异均有统计学意义(P均＜0.05).结论 肠减压导管以及奥曲肽治疗术后早期炎症性肠梗阻安全有效,肠减压导管的治疗时间更短,奥曲肽能够降低胃肠减压量.     

A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy.

OBJECTIVE: A meta-analysis of all published clinical trials comparing selective versus routine nasogastric decompression was performed in an attempt to evaluate the need for nasogastric decompression after elective laparotomy. BACKGROUND: Many studies have suggested that routine nasogastric decompression is unnecessary after elective laparotomy and may be associated with an increased incidence of complications. Despite these reports, many surgeons continue to practice routine nasogastric decompression, believing that its use significantly decreases the risk of postoperative nausea, vomiting, aspiration, wound dehiscence, and anastomotic leak. METHODS: A comprehensive search of the English language medical literature was performed to identify all published clinical trials evaluating nasogastric decompression. Twenty-six trials (3964 patients) met inclusion criteria. The outcome data extracted from each trial were subsequently "pooled" and analyzed for significant differences using the Mantel-Haenszel estimation of combined relative risk. RESULTS: Fever, atelectasis, and pneumonia were significantly less common and days to first oral intake were significantly fewer in patients managed without nasogastric tubes. Meta-analysis based on study quality revealed significantly fewer pulmonary complications, but significantly greater abdominal distension and vomiting in patients managed without nasogastric tubes. Routine nasogastric decompression did not decrease the incidence of any other complication. CONCLUSIONS: Although patients may develop abdominal distension or vomiting without a nasogastric tube, this is not associated with an increase in complications or length of stay. For every patient requiring insertion of a nasogastric tube in the postoperative period, at least 20 patients will not require nasogastric decompression. Routine nasogastric decompression is not supported by meta-analysis of the literature.     

Nasogastric suction after elective abdominal surgery: a randomised study.

The value of nasogastric tube decompression after elective abdominal operations was assessed in a randomised trial in which 97 patients were and 100 were not allocated postoperative nasogastric decompression. Only two patients in the latter group subsequently required decompression. There was no statistically significant difference in the incidence of mortality, complications (including vomiting) or time to return of intestinal motility between the two groups. There was a significantly higher incidence of sore throat (P less than 0.0001) and nausea (P less than 0.05) in patients who received nasogastric decompression. A postal questionnaire to 259 UK general surgeons (96% replied) revealed that postoperative nasogastric decompression was usually used by 92% of surgeons after a Polya gastrectomy, 72% after a small bowel anastomosis, 49% after a large bowel anastomosis and 20% after cholecystectomy. We conclude that such a routine is not justified and should be reserved for those patients developing specific complications.     

Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection

BACKGROUND: The value of routine nasogastric tube (NGT) decompression after elective hepatic resection has not been investigated. METHODS: Of 200 patients who had elective hepatic resection, including 68 who had previously had colorectal surgery, 100 were randomized to NGT decompression, where the NGT was left in place after surgery until the passage of flatus or stool, and 100 to no decompression, where the NGT was removed at the end of the operation. RESULTS: There was no difference between patients who had NGT decompression and those who did not in terms of overall surgical complications (15.0 versus 19.0 per cent respectively; P = 0.451) medical morbidity (61.0 versus 55.0 per cent; P = 0.391), in-hospital mortality (3.0 versus 2.0 per cent; P = 0.640), duration of ileus (mean(s.d.) 4.3(1.5) versus 4.5(1.7) days; P = 0.400) or length of hospital stay (14.2(8.5) versus 15.8(10.8) days; P = 0.220). Twelve patients randomized to no NGT decompression required reinsertion of the tube 3.9(1.9) days after surgery. Previous abdominal surgery had no influence on the need for NGT reinsertion. Severe discomfort was recorded in 21 patients in the NGT group and premature removal of the tube was required in 19. Pneumonia (13.0 versus 5.0 per cent; P = 0.047) and atelectasis (81 versus 67 per cent; P = 0.043) were significantly more common in the NGT group. CONCLUSION: Routine NGT decompression after elective hepatectomy had no advantages. Its use was associated with an increased risk of pulmonary complications.     

快速康复外科在胆道外科中应用的初探

目的 探讨快速康复外科(FTS)在胆道外科中应用的安全性及有效性.方法 将哈尔滨医科大学第一临床医学院2005年3月至2007年3月收治的234例接受腹腔镜胆囊切除术、小切口胆囊切除术、开腹胆总管探查切开取石术和肝管-空肠Roux-en-Y吻合术的病人随机分为对照组和FTS组.对照组采用传统的围手术期处理方法 ;FTS组采用加速康复的新型围手术期处理方法 ,主要包括术前口服碳水化合物,不留置鼻胃减压管和尿管;术中维持病人体温,控制补液量及不留置腹腔引流管;术后早期下床活动,早期进食和采取有效的镇痛措施等.结果 与传统对照组相比,FTS组病人的术后住院时间和输液时间明显缩短,术中出血量和治疗费用显著减少,术后首次排气、排便时间明显提前(P<0.05);两组手术时间并无显著差异.结论 在胆道外科中应用FTS治疗是安全、有效的,可以减少治疗费用,缩短住院时间,更好地促进病人早日康复.     

结直肠手术后早期进食的临床研究

目的 探讨结直肠术后早期进食的安全性、可行性及有效性.方法 选择2007年5月至2007年11月间行开腹结直肠切除术后的患者47例,随机分为早期进食组(试验组)与常规进食组(对照组).观察术后恢复过程、胃肠道功能恢复以及并发症发生率等.连续性变量以x±s表示,统计比较采用Student's t检验;分类变量以发生率的百分比表示,采用x2检验.结果 两组患者的年龄、手术方式、手术时间、合并症等无明显差异.两组均无围手术期死亡,对照组有1例患者出现吻合口漏与腹腔脓肿.试验组患者的首次排气排便时间(1.9±0.6)较对照组(2.8±0.9)早(P<0.01);术后静脉输液时间(3.8±0.9)亦较对照组(4.8 ± 1.2)短(P<0.01).试验组的术后住院时间(9.0±3.2)较对照组(10.0±3.3)短(P=0.27),腹胀的发生率分别为27%与44%(P=0.23),差异无统计学意义.试验组患者恶心、呕吐的发生率较对照组高,分别为31%与20%(P=0.35),但其差异无统计学意义.试验组与对照组各有2例患者因恶心、呕吐,或再次手术重新留置胃肠减压.对照组中有3例患者术后发热. 结论结直肠术后早期进食是安全可行的,可以有效促进术后恢复.     

A prospective randomized study of abdominal aortic surgery without postoperative nasogastric decompression

Nasogastric decompression following abdominal aortic aneurysmectomy or bypass, for 3–4 days, is a routine part of postoperative care in many centers. A prospective randomized study of 80 patients undergoing abdominal aortic surgery was performed in order to determine the necessity of prolonged nasogastric decompression. Patients were divided evenly between removal of the nasogastric tube upon tracheal extubation and retention of the tube until the passage of flatus. Preoperative risk factors, aortic cross-clamp time, estimated blood loss, length of procedure, length of intensive care unit stay, numbers of days with nasogastric tube, number of days until clear liquid and regular diets commenced, and the length of hospital stay were recorded for all patients. There were no significant differences in any of the measured variables between the two groups. The length of hospital stay was similar in both groups and three patients in each group required a nasogastric tube or reinsertion of one. In conclusion, the routine postoperative use of nasogastric tubes for abdominal aortic procedures is unnecessary. Copyright © 1996 The International Society for Cardiovascular Surgery.