经腹逆行胃管空肠营养管的临床应用及研究

Clinical application and research of abdominal retrograde gastric and jejunal feeding tube

目的总结经腹逆行胃管空肠营养管的临床应用及相关经验,并研究其使用价值。方法收集2014年1月1日至2016年12月31日就诊于浙江大学医学院附属第一医院住院行手术治疗的食管癌患者45例,分为应用鼻胃管+空肠造口管31例(对照组),应用逆行胃管+空肠造口管(经腹逆行胃管空肠营养管)14例(试验组),均行双切口食管癌切除术,45例患者的术后病理均为食管鳞状细胞癌。结果两组患者的一般资料包括性别、年龄、吸烟史、体质指数、术前白蛋白、术前丙氨酸氨基转移酶、术前天门冬氨酸氨基转移酶、术前血红蛋白、病变部位和病理分期,其P值均大于0.05,两组之间差异无统计学意义。两组患者的手术时间、术中出血量、术后24h和术后1周白蛋白、术后24h和术后1周血红蛋白、胃管留置时间、术后住院时间和术后并发症发生率,其P值均大于0.05,均无显著性差异。试验组术后24h胃管引流量少于对照组(P<0.05)。结论对于可切除的食管癌,经腹逆行胃管空肠营养管能有效完成术后胃肠减压和肠内营养,避免了经鼻置管给患者带来的鼻腔刺激等痛苦,值得进一步临床试验和推广。

Objective To summarize clinical application and experience of abdominal retrograde gastric and jejunal feeding tube and study its clinical value.Methods We viewed 45 adult patients with esophageal carcinoma treated with two-incision esophagectomy from January 1st,2014 to December 31th,2016 in Department of Thoracic Surgery,the First Affiliated Hospital of Zhejiang University.During the surgeries,31 patients were treated with nasogastric tube and jejunostomy tube(control group),and 14 patients were treated with retrograde gastric tube and jejunostomy tube(abdominal retrograde gastric and jejunal feeding tube,experimental group).All of them were diagnosed with esophageal squamous cancer according to the postoperative pathological results.Results Differences of general information between two groups including gender,age,body mass index,smoking history,preoperative albumin,preoperative alanine aminotransferase,preoperative aspartate aminotransferase,preoperative hemoglobin,location and pathological TNM stage were not statistically significant(P>0.05).Operative time,operative blood loss,postoperative albumin,postoperative hemoglobin,duration of using gastric tube,length of postoperative stay and complication rate between the two groups were not statistically different(P>0.05).The experimental group had less postoperative drainage volume of gastric tube in 24h(P<0.05).Conclusion For resectable esophageal carcinoma,abdominal retrograde gastric and jejunal feeding tube can provide effective gastrointestinal decompression and enteral nutrition while avoiding nasal irritation and inconvenience.So it deserves to be further studied and widely applied.