上消化道手术不破坏膈肌经胸腔鼻饲管置入术研究

Placement of nasal duodenal nutrition tube in upper gastrointestinal tract surgery

目的总结不破坏膈肌的情况下从胸腔手工置放鼻十二指肠营养管的经验和方法。方法连续选择食管癌Ivor-Lewis手术和贲门癌腔镜手术患者40例,其中食管癌患者35例,贲门癌手术5例,手术吻合结束后,护士从鼻腔置入鼻饲管,术者从胸腔辅助鼻饲管通过膈肌,触及幽门,选择适当角度和压力,将鼻饲管送入十二指肠。结果40例患者中,3例患者术中置放失败,失败者中1例为水囊鼻饲管,2例为导丝引导鼻饲管。术后鼻饲管脱出4例。术中及术后无不良反应。结论膈肌不破坏的上消化道手术,经胸腔辅助置放鼻十二指肠营养管安全有效,可以作为常规鼻饲管置入方法,取代部分有创肠内营养管置入术。

Objective To summarize the experience and method of manual placement of nasoduodenal feeding tube from thoracic cavity without destroying diaphragm.Methods 40 consecutive patients with esophageal cancer underwent Ivor-Lewis operation and endoscopic surgery for cardiac cancer,including 35 patients with esophageal cancer and 5 patients with cardiac cancer.After the operation,nurses inserted nasal feeding tube from the nasal cavity.The surgeon sent nasal feeding tube through the diaphragm,touched the pylorus,and selected appropriate angle and press Duodenum.Results Among the 40 patients,3 patients failed to insert the nasal feeding tube and 1 is liquid sac nasogastric feeding tube,2 are guide wire nasal feeding tube.There were 4 cases of nasogastric tube prolapse after operation.There was no adverse reaction during and after operation.Conclusion It is safe and effective to insert nasoduodenal feeding tube through thoracic cavity in upper gastrointestinal surgery without diaphragm damage.It can be used as a routine nasogastric feeding tube insertion instead of some invasive enteral feeding tube insertion.