Meissner K
Department of General Surgery, District Hospital, Tamsweg, Federal County of Salzburg, Austria.
Hepatogastroenterology. 2004 Mar-Apr;51(56):462-4.
BACKGROUND/AIMS: Adjunctive decompression gastrostomy has been a popular alternative to nasogastric suction in the care for general surgical patients suffering from postoperative ileus--avoiding discomfort and adverse sequelae of nasogastric tubes. Patient benefit thus correlates with procedural safety and ileus duration. These baseline data of decision-making were scrutinized in a general surgical patient population.
Retrospective analysis of a prospective data set. Two hundred and fifty-nine patients undergoing emergency (n=208) or elective procedures (n=51) received decompression gastrostomy when prolonged ileus or noncompliance with nasogastric suction were anticipated. Procedural complications, incidence of postoperative pneumonia and duration of postoperative ileus assessed by daily oral fluid intake vs. gastric drainage volumes were prospectively documented.
Gastrostomy complications comprised 0.4% with minor morbidity only. The incidence of pneumonia was 4.5%. Postoperative ileus was nil in 17%, 1-3 days in 48%, 4-5 days in 16%, 6-8 days in 12% and 9-23 days in 7%.
Adjuvant Stamm-Kader gastrostomy is a safe procedure. The incidence of pneumonia was comparatively low and a pertinent prophylactic effectivity appears plausible but remains unproven due to study design. Postoperative ileus exceeding 3 days affects 35%, exceeding 5 days 19% and exceeding 8 days only 7% of pertinent patients, and ileus duration cannot be predicted at the time of surgery. Thus, a substantial number of patients may be overtreated by prophylactic adjuvant surgical gastrostomy. The procedure improves patient's comfort and avoids complications of nasogastric suction. Prophylactic surgical gastrostomy remains a timely adjunct to general surgery but the indication should be individualized.
背景/目的：辅助减压胃造口术已成为普通外科术后肠梗阻患者护理中鼻胃管吸引的常用替代方法，可避免鼻胃管带来的不适和不良后遗症。患者的获益与手术安全性和肠梗阻持续时间相关。本研究在普通外科患者群体中对这些决策的基线数据进行了审查。
对前瞻性数据集进行回顾性分析。259例接受急诊手术（n = 208）或择期手术（n = 51）的患者，在预计会出现长时间肠梗阻或无法耐受鼻胃管吸引时接受了减压胃造口术。前瞻性记录手术并发症、术后肺炎发生率以及通过每日口服液体摄入量与胃引流量评估的术后肠梗阻持续时间。
胃造口术并发症发生率为0.4%，仅为轻微发病。肺炎发生率为4.5%。术后肠梗阻情况为：17%患者无肠梗阻，48%患者持续1 - 3天，16%患者持续4 - 5天，12%患者持续6 - 8天，7%患者持续9 - 23天。
辅助 Stamm - Kader 胃造口术是一种安全的手术。肺炎发生率相对较低，虽然由于研究设计，一种相关的预防有效性似乎合理，但尚未得到证实。超过3天的术后肠梗阻影响35%的相关患者，超过5天影响19%，超过8天仅影响7%，且手术时无法预测肠梗阻持续时间。因此，大量患者可能因预防性辅助手术胃造口术而受到过度治疗。该手术提高了患者的舒适度，避免了鼻胃管吸引的并发症。预防性手术胃造口术仍然是普通外科及时的辅助手段，但适应证应个体化。
