食管癌微创手术后不放胃管不禁食的可行性研究

Feasibility of “no tube no fasting” therapy in thoracolaparoscopic oesophagectomy for patients with oesophageal cancer

目的：探讨食管癌微创术后不进行胃肠减压并早期进食的可行性。方法前瞻性纳入2013年1月至2014年1月间在河南省肿瘤医院胸外科行微创手术治疗、且术后不放胃管不禁食（不常规留置胃肠减压管，术后第1天开始进食）的156例的食管癌患者（早期进食组）。并选取2012年1-12月间行微创手术治疗但接受传统围手术期处理（常规放置胃肠减压管及鼻肠营养管，术后第7天开始经口进食）的160例食管癌患者作为对照（晚期进食组）。结果早期进食组中有6例（3．8％）患者由于术后并发症未能按计划进行早期进食。早期进食组患者较晚期进食组术后排气时间[（2．1±0．9） d比（3．3±1．1） d，P＜0．01]、术后排粪时间[（4．4±1．3） d比（6．6±1．0） d，P＜0．01）及术后住院时间[（8．3±3．2） d比（10．4±3．6） d，P＜0．01]均显著缩短，但两组术后并发症发生率的差异无统计学意义[19．2％（30/156）比25．0％（40/160），P＞0．05]。多因素分析显示，早期经口进食是术后住院时间的独立影响因素（P＜0．01），但并不是术后并发症发生的独立危险因素（P＞0．05）。结论食管癌微创手术后不放置胃肠减压管以及早期进食是安全可行的，可以加快术后患者胃肠功能恢复，缩短术后住院时间，而且并不增加术后并发症发生率。

Objective To investigate the feasibility of no nasogastric intubation and early oral feeding at will after thoracolaparoscopic esophagectomy for patients with esophageal cancer. Methods Between January 2013 and January 2014, the feasibility of no nasogastric intubation and early oral feeding at postoperative day （POD） 1 after thoracolaparoscopic esophagectomy was prospectively investigated in 156 patients （trial group） with esophageal cancer in the Henan Cancer Hospital. One hundred and sixty patients previously managed in the same unit who were treated routinely after thoracolaparoscopic esophagectomy were served as control group. Results Of 156 patients of trial group, 6 （3.8%） patients could not take food early as planned because of postoperative complications. The overall complication rate in trial group was 19.2%（30/156）, which was 25.0%（30/160） in control group （P=0.217）. The anastomotic leakage in trial group and control group was 2.6%（4/156） and 4.3%（7/160） respectively （P=0.380）. Compared with control group, time to first flatus [（2.1±0.9） d vs. （3.3±1.1） d, P〈0.001], bowel movement[（4.4±1.3） d vs. （6.6±1.0） d, P〈0.001] and postoperative hospital stay [（8.3 ±3.2） d vs. （10.4 ±3.6） d, P〈0.001] were significantly shorter in trial group. Conclusions No nasogastric intubation and early oral feeding postoperatively in patients with thoracolaparoscopic esophagectomy is feasible and safe. This management can shorten postoperative hospital stay and fasten postoperative bowel function recovery.