微创食管癌术后不常规留置胃肠减压管的可行性研究

Feasibility study of removal of gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery

目的探讨微创食管癌术后不常规留置胃肠减压管的可行性。方法选取2016~2018年于哈尔滨医科大学附属第二医院胸外科行微创食管癌切除术的72例患者作为试验组,其中男68例、女4例,平均年龄(58.5±7.9)岁,术后均不留置胃肠减压管减压;选取2013~2015年行同一术式的70例患者作为对照组,其中男68例、女2例,平均年龄(59.1±6.9)岁,术后均留置胃肠减压管。观察并比较两组的术中、术后指标及并发症发生情况。结果两组患者在手术时间、术中出血量、术后血清白蛋白水平、术后经鼻空肠营养、术后是否入ICU、术后30 d内死亡及吻合口瘘、肺感染、呕吐、腹胀和声音嘶哑等并发症方面差异均无统计学意义(P>0.05)。两组患者均未发生胃排空障碍。与对照组相比,试验组术后肠鸣音恢复时间及术后首次排气时间明显缩短,总住院费用明显减少,恶心、咽干咽痛、呛咳、异物感和排痰困难等并发症发生率明显降低,差异具有统计学意义(P<0.05)。结论微创食管癌术后不常规留置胃肠减压管是切实可行的,并不会增加术后并发症发生率,反而加快患者的术后康复。

Objective To explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery.Methods Seventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery,The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years,who did not use gastric tube for gastrointestinal decompression after surgery.Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group,including 68 males and 2 females,with an average age of 59.1±6.9 years,who were indwelled with gastric tube for decompression after surgery.We observed and compared the intraoperative and postoperative indicators and complications of the two groups.Results There were no significant differences between the two groups in operation time,intraoperative blood loss,postoperative level of serum albumin,postoperative nasal jejunal nutrition,whether to enter the ICU postoperatively,death within 30 days after surgery,anastomotic leakage,lung infection,vomiting,bloating or hoarseness(P>0.05).No gastroparesis occurred in either group.Compared with the control group,the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter,and the total hospitalization cost,the incidence of nausea,sore throat,cough,foreign body sensation and sputum difficulty were significantly lower(P<0.05).Conclusion It is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery,which will not increase the incidence of postoperative complications,instead,accelerate the postoperative recovery of patients.