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

Feasibility of Thoracolapascopic Esophagectomy without Routine Nasogastric Intubation for Patients with Esophageal Cancer

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。

Objective To investigate the feasibility of thoracolapascopic esophagectomy （TLE） without routine nasogastric （NG） intubation for patients with esophageal cancer （EC）. Methods Clinical data of 78 EC patients undergoing TLE without perioperative NG intubation in Affiliated Cancer Hospital of Zhengzhou University from January to September 2013 were analyzed （non-NG intubation group, including 48 male and 30 female patients with their age of 61.1 ± 8.5 years）. Seventy-eight EC patients undergoing TLE with routine NG intubation for 7 days in 2012 were chosen as the control group （NG intubation group, including 50 male and 28 female patients with their age of 60.3 ± 7.0 years ）. Operation time, postoperative morbidity, gastrointestinal functional recovery and patient discomfort were compared between the 2 groups. Results There was no in-hospital death in either groups. There was no statistic difference in the incidences of pulmonary infection （ 16.7% vs. 19.2%, P=0.676）, anastomotic leakage （ 1.3% vs. 2.6%, P=0.560） or NG tube replacement （ 3.8% vs. 2.6%, P=0.649 ） between non-NG intubation group and NG intubation group. Time for recovery of intestinal motility （ 2.5 ± 1.1 days vs. 4.3 ± 1.2 days, P 〈 0.05 ） and time for air evacuation （3.6 ±1.7 days vs. 5.8 ± 2.1 days, P 〈 0.05 ） of non-NG intubation group were significantly shorter than those of NG intubation group. Ninety-seven percent of the patients （76/78） in NG intubation group had uncomfortable feeling including dry mouth and sore throat, and only 6% of the patients （5/78） in non-NG intubation group had nausea. All the patients were followed up for 3 months after discharge. There was no intestinal obstruction, pneumonia or late anastomotic leakage during follow-up. Conclusion TLE without routine NG intubation is safe and feasible for EC patients, which can not only reduce patients＇ discomfort but also improve early recovery of gastrointestinal function.