胰十二指肠切除术后不留置鼻胃及鼻肠营养管可行性研究

The feasibility of non-nasogastric and nasointestinal tube placement after pancreaticoduodenectomy

目的探讨在胰十二指肠切除术后不留置鼻胃和鼻肠营养管的安全性及可行性。方法回顾性分析2014年1月至2019年12月上海交通大学医学院附属新华医院普外科收治的238例胰十二指肠切除术病人的临床资料,其中110例不留置鼻胃及鼻肠营养管(未留置组),128例留置鼻胃及鼻肠营养管(留置组)。对比分析两组病人术后恢复情况、营养状况及术后并发症。结果未留置组与留置组病人的手术时间、术中出血量、术后首次肛门排气和排便时间差异均无统计学意义(P>0.05),但未留置组病人术后住院时间更短,住院费用明显降低,差异有统计学意义(P<0.01)。未留置组病人在消化道不适症状(咽喉疼痛、恶心呕吐)、肺部感染方面明显优于留置组(P<0.05),且未增加胰瘘、胆瘘、切口感染、胃排空延迟、术后出血、腹腔感染的发生率(P>0.05);两组在术后30 d死亡及二次手术方面差异无统计学意义(P>0.05)。术后第3、5天未留置组病人血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PAB)水平明显高于留置组,差异有统计学意义(P<0.01)。结论胰十二指肠切除术后病人不常规放置鼻胃及鼻肠营养管安全可行,有利于病人的术后康复,减轻痛苦,改善术后营养状况。

ObjectiveTo evaluate the safety and feasibility of non-nasogastric and nasointestinal tube afterpancreaticoduodenectomy.MethodsThe clinical data of 238 patients who underwent pancreaticoduodenectomy fromJanuary 2014 to December 2019 in Department of General Surgery,Xinhua Hospital Affliated to Shanghai Jiao TongUniversity School of Medicine were analyzed retrospectively.Of 238 patients,they were divided into non-nasogastric andnasointestinal tube placement group(no placement group,n=110)and nasogastric and nasointestinal tube placementgroup(placement group,n=128).Postoperative status,nutritional status and postoperative complications were measured.ResultsThere was no significant difference in operation time,intraoperative blood loss,first anal exhausting timebetween the two groups(P>0.05).No placement group had a shorter length and cheaper expense of hospital stay thanthose in control group(P<0.01).The gastrointestinal discomfort symptoms(throat pain,nausea and vomiting)andpulmonary infection in the no placement group were significantly better than those in the placement group(P<0.05).Anus exhausting time was no significantly difference in two groups(P>0.05).The level of Hb,PAB and ALB in noplacement group were higher than those in placement group on the 3 st and 5 th day after surgery(P<0.001).Conclusion Current evidence shows non-nasogastric and nasointestinal tube after pancreaticoduodenectomyare safety and feasibility and can promote thepostoperative body recovery and alleviate surgicalstress.