Ichida Hirofumi, Imamura Hiroshi, Yoshimoto Jiro, Sugo Hiroyuki, Ishizaki Yoichi, Kawasaki Seiji
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
J Gastrointest Surg. 2016 Jul;20(7):1324-30. doi: 10.1007/s11605-016-3116-0. Epub 2016 May 19.
The value of routine nasogastric tube (NGT) decompression after elective hepatetctomy is not yet established. Previous studies in the setting of non-liver abdominal surgery suggested that the use of NGT decreased the incidence of nausea or vomiting, while increasing the frequency of pulmonary complications.
Out of a total of 284 consecutive patients undergoing hepatectomy, 210 patients were included in this study. The patients were randomized to a group that received NGT decompression (NGT group; n = 108), in which a NGT was left in place after surgery until the patient passed flatus or stool, or a group that did not receive NGT decompression (no-NGT group; n = 102), in which the NGT was removed at the end of surgery.
There were no differences between the NGT group and no-NGT group in terms of the overall morbidity (34.3 vs 35.3 %; P = 0.99), incidence of pulmonary complications (18.5 vs 19.5 %; P = 0.84), frequency of postoperative vomiting (6.5 vs 7.8 %; P = 0.70), time to start of oral intake (median (range) 3 (2-6) vs 3 (2-6) days; P = 0.69), or postoperative duration of hospital stay (19 (7-74) vs 18 (9-186) days; P = 0.37). In the no-NGT group, three patients required reinsertion of the tube 0 (0-3) days after surgery. In the NGT group, severe discomfort was recorded in five patients.
Routine NGT decompression after elective hepatectomy does not appear to have any advantages.
择期肝切除术后常规鼻胃管（NGT）减压的价值尚未确定。以往在非肝脏腹部手术中的研究表明，使用NGT可降低恶心或呕吐的发生率，但会增加肺部并发症的发生频率。
在连续接受肝切除的284例患者中，本研究纳入了210例患者。患者被随机分为接受NGT减压的组（NGT组；n = 108），术后留置NGT直至患者排气或排便，以及未接受NGT减压的组（非NGT组；n = 102），手术结束时拔除NGT。
NGT组和非NGT组在总体发病率（34.3%对35.3%；P = 0.99）、肺部并发症发生率（18.5%对19.5%；P = 0.84）、术后呕吐频率（6.5%对7.8%；P = 0.70）、开始经口进食时间（中位数（范围）3（2 - 6）天对3（2 - 6）天；P = 0.69）或术后住院天数（19（7 - 74）天对18（9 - 186）天；P = 0.37）方面均无差异。在非NGT组中，3例患者在术后0（0 - 3）天需要重新插管。在NGT组中，有5例患者记录有严重不适。
择期肝切除术后常规NGT减压似乎没有任何优势。
