Kobayashi Takaaki, Masaki Tadahiko, Kogawa Koji, Matsuoka Hiroyoshi, Sugiyama Masanori
1 Department of Surgery, Kyorin University Hospital, Tokyo, Japan 2 Department of Surgery, Kanto Central Hospital, Tokyo, Japan.
Dis Colon Rectum. 2015 Nov;58(11):1058-63. doi: 10.1097/DCR.0000000000000452.
Prolonged intestinal paralysis can be a problem after gastrointestinal surgery. Several systematic reviews and meta-analyses have suggested the efficacy of gum chewing for the prevention of postoperative ileus.
The purpose of this study was to examine the efficacy of gum chewing for the recovery of bowel function after surgery for left-sided colorectal cancer and to determine the physiological mechanism underlying the effect of gum chewing on bowel function.
This was a single-center, placebo-controlled, parallel-group, prospective randomized trial.
The study was conducted at a general hospital in Japan.
Forty-eight patients with left-sided colorectal cancer were included.
The patients were randomly assigned to a gum group (N = 25) and a control group (N = 23). Four patients in the gum group and 1 in the control group were subsequently excluded because of difficulties in continuing the trial, resulting in the analysis of 21 and 22 patients in the respective groups. Patients in the gum group chewed commercial gum 3 times a day for ≥5 minutes each time from postoperative day 1 to the first day of food intake.
The time to first flatus and first bowel movement after the operation were recorded, and the colonic transit time was measured. Gut hormones (gastrin, des-acyl ghrelin, motilin, and serotonin) were measured preoperatively, perioperatively, and on postoperative days 1, 3, 5, 7, and 10.
Gum chewing did not significantly shorten the time to the first flatus (53 ± 2 vs. 49 ± 26 hours; p = 0.481; gum vs. control group), time to first bowel movement (94 ± 44 vs. 109 ± 34 hours; p = 0.234), or the colonic transit time (88 ± 28 vs. 88 ± 21 hours; p = 0.968). However, gum chewing significantly increased the serum levels of des-acyl ghrelin and gastrin.
The main limitation was a greater rate of complications than anticipated, which limited the significance of the findings.
Gum chewing changed the serum levels of des-acyl ghrelin and gastrin, but we were unable to demonstrate an effect on the recovery of bowel function.
胃肠道手术后，肠道麻痹时间延长可能成为一个问题。多项系统评价和荟萃分析表明咀嚼口香糖对预防术后肠梗阻有效。
本研究旨在探讨咀嚼口香糖对左侧结直肠癌手术后肠道功能恢复的疗效，并确定咀嚼口香糖影响肠道功能的生理机制。
这是一项单中心、安慰剂对照、平行组、前瞻性随机试验。
该研究在日本一家综合医院进行。
纳入48例左侧结直肠癌患者。
患者被随机分为口香糖组（N = 25）和对照组（N = 23）。口香糖组有4例患者，对照组有1例患者随后因难以继续试验而被排除，最终分别对两组中的21例和22例患者进行分析。口香糖组患者从术后第1天至开始进食的第一天，每天咀嚼商业口香糖3次，每次≥5分钟。
记录术后首次排气和首次排便的时间，并测量结肠转运时间。术前、围手术期以及术后第1、3、5、7和10天测量肠道激素（胃泌素、去酰基胃饥饿素、胃动素和5-羟色胺）。
咀嚼口香糖并未显著缩短首次排气时间（53±2 vs. 49±26小时；p = 0.481；口香糖组 vs. 对照组）、首次排便时间（94±44 vs. 109±34小时；p = 0.234）或结肠转运时间（88±28 vs. 88±21小时；p = 0.968）。然而，咀嚼口香糖显著提高了去酰基胃饥饿素和胃泌素的血清水平。
主要局限性是并发症发生率高于预期，这限制了研究结果的意义。
咀嚼口香糖改变了去酰基胃饥饿素和胃泌素的血清水平，但我们未能证明其对肠道功能恢复有影响。
