直肠癌前切除术后常规放置胃肠减压管并禁食与不留置鼻胃管并早期进食的对比研究

目的探讨直肠癌前切除患者术后不留置胃管和早期进食的安全性和可行性。方法选择2010年1～12月在本院住院的直肠癌前切除手术患者185例,根据术后是否经鼻留置胃管分为常规胃肠减压组115例(A组),非胃肠减压组70例(B组)。比较两组患者术后呕吐、腹胀、肠梗阻、吻合口漏等术后并发症,肛门恢复排气时间,住院天数、总费用等。结果 A组发生术后呕吐13例、肠梗阻1例、吻合口漏2例,B组发生术后呕吐7例、无肠梗阻、吻合口漏1例,两组比较,差异无统计学意义(P>0.05),A组住院总费用(4.75±3.98)万元与B组(3.98±1.06)万元比较,差异无统计学意义(P>0.05)。A组术后7例发生腹胀,虽较B组11例少,但差异无统计学意义(P=0.077)。A组肛门恢复排气时间(3.1±1.0)d、排便时间(5.4±1.9)d与B组[(2.5±1.2)d,(4.7±1.6)d]相比显著延迟(P<0.05)。A组患者住院时间(10.5±4.0)d明显较B组(8.5±2.0)d延长(P<0.01)。结论 直肠癌前切除患者术后不留置胃管和早期近食是安全可行的。

Comparisons between intubation with gastrointestinal decompression tube plus fasting and no intubation plus early feeding in patients undergoing anterior resection

Objective To investigate the security and feasibility of early feeding without intubation with gastrointestinal decompression tube in patients undergoing anterior resection. Methods 185 patients with rectal cancers managed with anterior resection during January to December 2010 were divided, according to whether to conduct intubation or not, into gastrointestinal decompression group （n = 115） and non-gastrointestinal decompression group （n = 70）. The two groups were compared in terms of postoperative vomiting, abdominal distention, time for anal venting, complications of bowel obstruction and stomal leak, hospitalization duration and total costs. Results In gastrointestinal decompression group, there were 13 cases of vomiting, 1 case of abdominal distention, 2 cases of stoma] leak and 7 cases of abdominal distention. In the non-gastrointestinal decompression groups, there were 7 eases of vomiting, no case of abdominal distention, 1 cases of stomal leak and 11 cases of abdominal distention. There were no significant differences between the two groups （all P 〉 0.05）. The total costs for the two groups were （47.5 ± 39.8） thousand yuan and （39.8 ± 10.6） thousand ynan, showing insignificant difference between them （P 〉 0.05）. In the gastrointestinal decompression group, the time for anal venting and the time for defecation were （3.1 ±1.0）d and （5.4 ± 1.9）d, which were significantly different from （2.5 ± 1.2）d, （4.7 ±1.6）d of the non-gastrointestinal decompression group （P 〈 0.05）. The hospitalization duration in the former gruup was significantly longer than that of the latter （10.5 ± 4.0 d vs.8.5 ±2.0 d, P 〈 0.05）. Conclusion Earlier feeding without intubation with gastrointestinal deeonpression tube can be safe and feasible.