早期拔除胃管对于全胃切除术后功能恢复的 影响分析

Impact of early nasogastric tube removal on functional recovery after total gastrectomy

目的探讨早期拔除胃管对胃癌患者全胃切除术后功能恢复情况的影响, 以提供胃癌术后快速康复策略的科学依据。方法采用回顾性队列研究方法, 分析2018年3月-2022年7月于首都医科大学附属北京友谊医院接受全胃切除的102例胃癌患者的病例资料。按照胃管留置时间是否超过24 h分为早期拔除胃管组(n=55)与非早期拔除胃管组(n=47), 对比两组患者术后恢复情况, 包括排气时间、进水时间、住院时间以及术后并发症发生率的差异。非正态分布的计量资料以M(Q_(1), Q_(3))表示, 组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ^(2)检验或Fisher确切概率法;为减少潜在混杂因素的影响, 进一步使用倾向性评分校正的多元线性回归和Logistic回归分析, 比较两组患者临床数据的差异。结果早期拔除胃管组的术后排气时间、进水时间及住院时间分别为3.0(2.0, 3.5) d、4.0(3.0, 5.0) d及7.0(7.0, 8.0) d, 非早期拔除胃管组分别为4.0(3.0, 5.0) d、6.0(5.0, 7.0) d及8.0(7.5, 11.0) d, 两组相比差异具有统计学意义(P<0.05)。而两组患者在术后并发症发生率方面差异无统计学意义(5.45%比17.02%, P=0.060);倾向性评分调整的回归分析进一步表明, 早期拔除胃管可能降低术后并发症发生的风险(P=0.042)。结论早期拔除胃管可以显著加快胃癌全胃切除术后患者的功能恢复过程, 并可降低术后并发症发生的风险, 为胃癌术后快速康复管理提供了重要的临床实践指导。

Objective To investigate the impact of early removal of nasogastric tubes on functional recovery after total gastrectomy for gastric cancer patients,to provide scientific evidence for enhanced recovery after surgery strategies in gastric cancer.Methods A retrospective cohort study was conducted on 102 gastric cancer patients who underwent total gastrectomy at Beijing Friendship Hospital affiliated with the Capital Medical University from March 2018 to July 2022.Patients were divided into two groups based on whether the gastric tube was removed within 24 hours post-operation:the early removal group(within 24 hours,55 patients)and the non-early removal group(beyond 24 hours,47 patients).The recovery outcomes,including time to first flatus,time to fluid intake length of hospital stay,and the incidence of postoperative complications,were compared between the two groups.Non-normally distributed data were expressed as M(Qi,Q,)and compared using the Wilcoxon rank-sum test.Categorical data were expressed as frequencies or percentages and compared using the chi-square test or Fisher's exact test.To minimize the impact of potential confounders,multivariable linear regression and logistic regression analyses adjusted for propensity scores were further employed to compare quantitative and qualitative data between the groups.Statistical analyses were performed using R software.Results The exhaust time,water intake time,and hospital stay in the early removal group were 3.0(2.0,3.5)days,4.0(3.0,5.0)days,and 7.0(7.0,8.0)days,respectively,while those in the non-early removal group were 4.0(3.0,5.0)days,6.0(5.0,7.0)days,and 8.0(7.5,11.0)days,respectively.Statistically significant differences were observed between the two groups(P<O.05).However,there was no significant dfference in the incidence of postoperative complications between the two groups(5.45%us 17.02%,P=0.060).Propensity score-adjusted regression analysis suggested that early tube removal might reduce the risk of postoperative complications(P=0.042).Conclusion Early removal of nasogastric tubes can significantly accelerate functional recovery after total gastrectomy for gastric cancer patients and may reduce the risk of postoperative complications,providing important clinical guidance for enhanced recovery after surgery management in gastric cancer.