胃癌手术无胃肠减压的安全性及意义

Gastric cancer surgery without nasogastric decompression

胃癌患者的围手术期常规放置鼻胃肠减压(nasogastric decompression,ND),作为一种习惯与传统,却一直延用至今.一般认为,对于胃肠道的手术,放置ND可以降低吻合部位内部压力,减少吻合口漏概率.但迄今并没有严格科学的循证医学证据,特别是前瞻性研究结论.近年来多项研究表明术后常规ND不能缩短肠道功能恢复的时间及降低吻合口漏发生率,不行ND并未增加吻合口漏的风险,各种胃癌手术均可安全地在无ND状态下顺利完成,极大地减少患者痛苦,术后恢复加快,同时医护人员工作量显著降低.对于术前有幽门梗阻、出血的患者,如果术前放置ND,术后患者清醒后即可拔除,无ND技术对于胃癌手术是安全的,值得临床推广使用.故本文针对胃癌手术无胃肠减压的安全性及意义作一综述.

Nasogastric decompression （ND） has been used worldwide in gastric cancer surgery as a traditional way since Hunter pioneered. Most surgeons believe that using ND in abdominal surgery could relieve the internal pressure of anastomosis and reduce the incidence of anastomotic leakage. However, there has no strict scientific evidence for this obtained from medical studies, especially prospective stud- ies. In recent years, several studies have shown that routine use of ND after surgery could not prevent anastomotic leakage or accelerate the recovery of bowel function, and surgery with- out ND did not increase the risk of anastomotic leakage. All kinds of gastric cancer surgery could be performed safely without ND, which greatly reduces the suffering of the patients, ac- celerates postoperative recovery, and reducesthe workload significantly. If patients with py- loric obstruction or bleeding receive ND before surgery, nasogastric tube could be removed after they waked up. Gastric cancer surgery without ND is safe and deserves clinical popu- larization. This review summarizes the safety and significance of gastric cancer surgery with- out ND.