Schuchert Matthew J, Pettiford Brian L, Landreneau Joshua P, Waxman Jonathon, Kilic Arman, Santos Ricardo S, Kent Michael S, El-Sherif Amgad, Abbas Ghulam, Luketich James D, Landreneau Rodney J
Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Shadyside Medical Building-Suite 715, 5200 Centre Avenue, Pittsburgh, PA 15232, USA.
J Gastrointest Surg. 2008 Sep;12(9):1479-84. doi: 10.1007/s11605-008-0541-8. Epub 2008 Jun 17.
Standard nasogastric decompression following esophagectomy is associated with reduced patient comfort and mobility and impaired hypopharyngeal function--predisposing the patient to sinusitis, pharyngitis, and the risk of aspiration. In this study, we evaluate the results of the transcervical gastric tube drainage in the setting of esophagectomy.
Transcervical gastric tube decompression was performed on 145 consecutive patients undergoing open esophagectomy between 2003 and 2007. Postoperative outcome variables include morbidity, mortality, esophagostomy duration, and length of stay.
There were 107 males and 38 females (median age = 66; range = 37-87). Perioperative mortality was 2.8%. Major complications included five anastomotic leaks (3.4%), ten pneumonias (6.9%), two myocardial infarctions (1.4%), and the need for reoperation in four patients (bleeding, dehiscence). Median duration of transcervical drainage was 8 days. No tubes were dislodged prematurely. There were no bleeding complications. Four patients developed cellulitis near the cervical gastric tube site and were treated successfully with antibiotics and/or tube removal.
Transcervical gastric decompression can be performed safely with minimal complication risk. Inadvertent tube removal was not encountered in this series. The use of this technique may help to promote accelerated patient mobilization, greater patient comfort, and a durable means of gastric decompression.
食管癌切除术后标准的鼻胃管减压会降低患者舒适度和活动能力，并损害下咽功能，使患者易患鼻窦炎、咽炎及有误吸风险。在本研究中，我们评估了经颈胃管引流在食管癌切除术中的效果。
对2003年至2007年间连续145例行开放性食管癌切除术的患者进行经颈胃管减压。术后结果变量包括发病率、死亡率、食管造口持续时间和住院时间。
男性107例，女性38例（中位年龄 = 66岁；范围 = 37 - 87岁）。围手术期死亡率为2.8%。主要并发症包括5例吻合口漏（3.4%）、10例肺炎（6.9%）、2例心肌梗死（1.4%），4例患者需要再次手术（出血、裂开）。经颈引流的中位持续时间为8天。无导管过早脱出。无出血并发症。4例患者在颈胃管部位附近发生蜂窝织炎，经抗生素治疗和/或拔除导管后成功治愈。
经颈胃减压可安全进行，并发症风险极小。本系列未出现意外拔管情况。使用该技术可能有助于促进患者更快活动、提高舒适度，并提供一种持久的胃减压方法。
