胃癌根治术后常规留置胃管必要性的荟萃分析

Necessity of routine nasogastric decompression after gastrectomy for gastric cancer： a Meta-analysis

目的从循证医学角度探讨胃癌根治术后常规留置胃管（NGT）的必要性。方法检索2011年9月2013前已公开发表的前瞻性随机对照试验（RCT）。按纳入标准筛选后进行质量评分，提取临床效应指标，采用RevMan5．1软件对所纳入的数据进行荟萃分析。结果共纳人RCT文献7篇，样本总量871例，其中留置胃管组436例，不留置胃管组435例。荟萃分析结果显示，与留置胃管组相比，不留置胃管组患者术后肛门排气时间早（WMD=0．10d，95％C10．00—0．30，P=0．05），进食时间早（WMD=0．43d，95％C10．25～0．61，P〈0．01），术后住院天数短（WMD=0．60d，95％C10．15—1．18，P=0．01），肺部并发症少（RR=1．30，95％CI1．00～1．68，P=0．05）；而术后吻合口漏、总体并发症率及死亡率两组间差异无统计学意义。结论胃癌根治术后除患者有明显的呕吐、腹胀等胃管放置指证外，应避免常规留置胃管。

Objective To evaluate the necessity of routine nasogastric decompression after radical gastrectomy for gastric cancer with systematic review and Meta-analysis. Methods The literature databases prior to September 2011 were extensively searched to retrieve the randomized controlled trials （RCT） with a relevance of study goal. The inclusion and exclusion criteria were formulated. After quality evaluation, the data were extracted. The Cochrane collaboration RevMan 5.1 version software was used for Metaanalysis. Results Seven RCT studies fulfilled the inclusion criteria for Meta-analysis. The total sample size of these studies was 871 cases. Those without a nasogastric tube routinely inserted experienced a marginal earlier time to flatus [ weighted mean difference （WMD） --- 0. 10 days, 95% confidence interval （CI） 0. 00 - 0. 30, P = 0. 05 ], a significant earlier time to oral diet [ WMD = 0. 43 days, 95% CI O. 25 - O. 61, P 〈 0. 01 ], a significant shorter hospital stay [ WMD = 0. 60 days, 95% CI 0. 15 - 1.18, P = 0.01 ） and a marginal decrease in pulmonary complications [ relative risk （RR） = 1.30, 95% CI 1.00 - 1.68, P = 0. 05） ]. The postoperative rates of anastomotic leakage, morbidity and mortality were similar between two groups. Conclusion Except for severe vomiting or abdominal distension, nasogastric tubes should not be used routinely in gastric cancer patients undergoing radical surgery.