Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy

瞄准：评估早移开胃肠的解压缩并且在为颜色经历外科的病人的早口头的喂的可行性，安全，和忍耐表面的癌。方法：提交到从 2004 年 1 月与结肠直肠吻合术联系到 2005 年 9 月的操作的 316 个病人被使随机化到二个组：在试验性的组(n=161 ) ， nasogastric 试管从 12 ～ 24 h 在操作以后被移开并且被答应立即口头的喂；在控制组(n=155 ) ， nasogastric 试管被维持直到屁经直肠的经过。估计的变量包括了时间到屁的第一个段落，凳子的第一个段落的时间，时间过去了手术后的停留，和手术后的复杂并发症象吻合漏，胃的尖锐膨胀，创伤感染和 dehiscense，发烧，肺的感染和咽喉炎那样。结果：中部、平均的天到屁的第一个段落(3.0+/-0.9 对 3.6+/-1.2， P【0.001 ) ，凳子的第一个段落(4.1+/-1.1 对 4.8+/-1.4， P【0.001 ) 并且手术后的停留的长度(8.4+/-3.4 对 9.6+/-5.0， P【0.05 ) 比在控制组在试验性的组是更短的。象吻合漏(1.24%对2.58%)那样的手术后的复杂并发症，胃(1.86%对0.06%)的尖锐膨胀和创伤复杂并发症(2.48%对1.94%)在这些组，而是发烧是类似的(3.73%对9.68%， P【0.05 )，肺的感染(0.62%对4.52%， P【0.05 )并且咽喉炎(3.11%对23.23%， P【0.001 )更在里面控制比在试验性的组组织。结论：在结肠直肠吻合术不能有效地减少手术后的复杂并发症以后，现在的学习显示出胃肠的解压缩的那应用。相反，它可以增加发烧，咽喉炎和肺的感染的发生率。早移开胃肠的解压缩并且在经历结肠直肠吻合术的病人的早口头的喂的这些策略与减少的手术后的不快可行、安全、联系并且能加速肠功能的回来并且改进康复。

AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.