下消化道切除及吻合术后的胃肠减压
Gastrointestinal decompression after excision and anastomosis of lower digestive tract.
作者信息
Lei Wen-Zhang, Zhao Gao-Ping, Cheng Zhong, Li Ka, Zhou Zong-Guang
机构信息
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
出版信息
World J Gastroenterol. 2004 Jul 1;10(13):1998-2001. doi: 10.3748/wjg.v10.i13.1998.
AIM
To discuss the clinical significance of postoperative gastrointestinal decompression in operation on lower digestive tract.
METHODS
Three hundred and sixty-eight patients with excision and anastomosis of lower digestive tract were divided into two groups, i.e. the group with postoperative gastrointestinal decompression and the group without postoperative gastrointestinal decompression. Clinical therapeutic outcome and incidence of complication were compared between two groups. Furthermore, an investigation on application of gastrointestinal decompression was carried out among 200 general surgeons.
RESULTS
The volume of gastric juice in decompression group was about 200 mL every day after operation. Both groups had a lower girth before operation than every day after operation. No difference in length of the first passage of gas by anus and defecation after operation was found between two groups. The overall incidence of complications was obviously higher in decompression group than in non-decompression group (28% vs 8.2%, P<0.001). The incidence of pharyngolaryngitis was up to 23.1%. There was also no difference between two groups regarding the length of hospitalization after operation. The majority (97.5%) of general surgeons held that gastrointestinal decompression should be placed till passage of gas by anus, and only 2.5% of surgeons thought that gastrointestinal decompression should be placed for 2-3 d before passage of gas by anus. Nobody (0%) deemed it unnecessary for placing gastrointestinal compression after operation.
CONCLUSION
Application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce gastrointestinal tract pressure and has no obvious effect on preventing postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial to the recovery of patients without undergoing gastrointestinal decompression.
目的
探讨下消化道手术术后胃肠减压的临床意义。
方法
将368例行下消化道切除吻合术的患者分为两组，即术后胃肠减压组和术后未行胃肠减压组。比较两组的临床治疗效果及并发症发生率。此外，对200名普通外科医生进行了胃肠减压应用情况的调查。
结果
减压组术后每日胃液量约200 mL。两组术前腹围均低于术后每日腹围。两组术后肛门首次排气和排便时间无差异。减压组并发症总发生率明显高于非减压组（28%对8.2%，P<0.001）。咽炎发生率高达23.1%。两组术后住院时间也无差异。大多数（97.5%）普通外科医生认为胃肠减压应持续至肛门排气，只有2.5%的医生认为应在肛门排气前2 - 3天进行胃肠减压。没有人（0%）认为术后不需要进行胃肠减压。
结论
下消化道切除吻合术后应用胃肠减压不能有效降低胃肠道压力，对预防术后并发症无明显作用。相反，它可能增加咽炎等并发症的发生率。因此，不行胃肠减压对患者的恢复更有益。
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