Whipple胰十二指肠切除术围手术期不安置鼻胃管的可行性研究

The feasibility study of non-nasogastric tube placement throughout the perioperative period of classical Whipple pancreaticoduodenectomy

目的探讨经典Whipple胰十二指肠切除术围手术期全程不安置鼻胃管的安全性及可行性。方法回顾性分析2020年6月至2023年8月期间在四川大学华西医院行Whipple胰十二指肠切除术的63例患者的临床资料,根据围手术期全程是否安置鼻胃管分为鼻胃管组32例和无鼻胃管组31例。比较2组患者的胃肠吻合方式等术中指标,以及术后住院时间等结局指标。结果①术前基线资料:无鼻胃管组的良性疾病占比(P=0.005)及术前合并胰腺炎比例(P=0.003)高于鼻胃管组,其他术前基线资料如年龄、性别等比较差异均无统计学意义(P>0.05)。②术中指标:无鼻胃管组胃肠吻合采用管型吻合器的比例较高(P=0.009),且手术时间较短(P<0.001),但胰肠吻合方式、术中输血和术中出血量比较差异均无统计学意义(P>0.50)。③术后结局指标:无鼻胃管组术后住院时间(P<0.001)及胃排空延迟发生率(P<0.001)均低于鼻胃管组,但术后开始进食时间、胰瘘发生率、术后出血发生率及并发症Clavien-Dindo分级比较差异均无统计学意义(P>0.05),且2组均无30 d内死亡病例。结论本研究结果初步表明,经典Whipple胰十二指肠切除术患者围手术期全程不安置鼻胃管安全可行,与插鼻胃管相比可缩短患者术后住院时间,降低术后胃排空延迟发生率。

Objective To evaluate the safety and feasibility of non-nasogastric tube throughout the perioperative period of classical Whipple pancreaticoduodenectomy.Methods A retrospective analysis was conducted on the clinical data of 63 patients who underwent Whipple pancreaticoduodenectomy at West China Hospital of Sichuan University from June 2020 to August 2023.According to whether nasogastric tube was placed throughout the perioperative period,the patients were divided into nasogastric tube group(NGT group,n=32)and no nasogastric tube group(no NGT group,n=31).The intraoperative indicators such as gastrointestinal anastomosis mode and outcome measures such as postoperative hospital stay were compared between the two groups.Results①Preoperative baseline data:the proportion of benign diseases(P=0.005)and preoperative pancreatitis(P=0.003)of the no NGT group were higher than those of the NGT group,and other preoperative baseline data,such as age and sex,were not statistically significant(P>0.05).②Intraoperative index:the proportion of circular stapler(P=0.009)was smaller and the operation time was shorter(P<0.001),but there was no significant difference in the anastomosis,intraoperative blood transfusion and intraoperative bleeding(P>0.05).③Postoperative outcome measures:the postoperative length of hospital stay(P<0.001)and the incidence of delayed gastric emptying(P<0.001)of the no NGT group were lower than those in the NGT group,but the postoperative time of food intake,incidence of pancreatic fistula,incidence of postoperative bleeding,and Clavien-Dindo grade of complications were not significant(P>0.05),and on one died within 30 d after operation.Conclusions The results of this study preliminarily show that,it is safe and feasible not to place nasogastric tubes throughout the perioperative period in patients undergoing classical Whipple pancreaticoduodenectomy.Compared with placing nasogastric tube,it can shorten the postoperative hospital stay,reduce the incidence of postoperative delayed gastric emptying.