Hoffmann S, Koller M, Plaul U, Stinner B, Gerdes B, Lorenz W, Rothmund M
Department of General Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
Langenbecks Arch Surg. 2001 Nov;386(6):402-9. doi: 10.1007/s00423-001-0257-7. Epub 2001 Nov 8.
Perioperative decompression of the stomach is still a common procedure and can be achieved using either nasogastric tubes (NTs) or gastrostomy tubes (GTs). While both procedures appear to be equally effective, some authors believe that NTs are less convenient for patients than GTs. However, to date, no reliable prospective data are available on this issue.
We conducted a prospective, randomized trial comparing NTs versus GTs with a total of 110 patients undergoing elective colon surgery. The primary outcome measure was the patient's tube-related inconvenience and pain, assessed in a standardized interview on day 2 after surgery and quantified by means of a visual-analog scale (VAS). A questionnaire including the EORTC QLQ-C30 and additional items regarding retrospective tube-related judgements was administered on the day of discharge and 4 weeks after discharge. Secondary endpoints were the therapy-related morbidity and general complications.
When patients were asked which of their drainage tubes (all patients had three or four drainage tubes, such as decompression drains, urinary drains, central venous line) was most inconvenient, 43% (CI 33-53%) in the NT group reported that the NT was most inconvenient, while only 4% (CI 1-10%) of the GT patients judged the GT most inconvenient ( P<0.001, Chi(2) test). This effect was also found in VAS ratings of inconvenience and discomfort ( P<0.01). Also postoperatively (p.o.), NT patients evidenced less preference for their tube system (day 2 p.o.: 71%, CI 61-80%; 4 weeks p.o.: 66%, CI 56-75%) than did GT patients (day 2 p.o.: 94%, CI 88-98%; 4 weeks p.o.: 91% CI 84-96%); again, these differences were statistically significant ( P<0.02; Chi(2) test). No differences between groups emerged regarding global quality of life or conventional clinical outcomes.
This prospective randomized trial supports the clinical observation that NT causes more subjective inconvenience than GT. In cases when a prolonged postoperative ileus is expected, decisions for a prophylactic decompressing tube system have to weigh up the possibilities of different averse clinical as well as subjective outcomes. It is then preferable to include patients' preferences in the individual decision making process (shared-decision making).
围手术期胃减压仍是一种常见的操作，可通过鼻胃管（NTs）或胃造瘘管（GTs）来实现。虽然这两种操作似乎同样有效，但一些作者认为，与GTs相比，NTs对患者来说不太方便。然而，迄今为止，关于这个问题尚无可靠的前瞻性数据。
我们进行了一项前瞻性随机试验，比较NTs和GTs，共有110例接受择期结肠手术的患者参与。主要结局指标是患者与导管相关的不便和疼痛，在术后第2天通过标准化访谈进行评估，并通过视觉模拟量表（VAS）进行量化。在出院当天和出院后4周发放一份问卷，其中包括欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）以及关于回顾性导管相关判断的其他项目。次要终点是与治疗相关的发病率和一般并发症。
当询问患者哪根引流管（所有患者有三到四根引流管，如减压引流管、尿管、中心静脉导管）最不方便时，NT组中43%（95%置信区间33%-53%）的患者报告说NT最不方便，而GT组中只有4%（95%置信区间1%-10%）的患者认为GT最不方便（P<0.001，卡方检验）。在不便和不适的VAS评分中也发现了这种效应（P<0.01）。术后（p.o.），NT组患者对其导管系统的偏好也低于GT组患者（术后第2天：71%，95%置信区间61%-80%；术后4周：66%，95%置信区间56%-75%），而GT组患者分别为94%（95%置信区间88%-98%）和91%（95%置信区间84%-96%）；同样，这些差异具有统计学意义（P<0.02；卡方检验）。在总体生活质量或传统临床结局方面，两组之间没有差异。
这项前瞻性随机试验支持了临床观察结果，即NT比GT会导致更多的主观不便。在预期术后肠梗阻持续时间较长的情况下，对于预防性减压导管系统的决策必须权衡不同不良临床结局和主观结局的可能性。此时，在个体决策过程中最好纳入患者的偏好（共同决策）。
