Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK.
East Midlands Surgical Academic Network (EMSAN), Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK.
J Gastrointest Surg. 2020 Nov;24(11):2643-2653. doi: 10.1007/s11605-019-04507-3. Epub 2020 Feb 26.
Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of the multimodal approaches to expedite recovery after surgery, strong evidence to support its use in routine postoperative practice is lacking.
A comprehensive literature review of all randomised controlled trials (RCTs) was performed in the Medline and Embase databases between 2000 and 2019. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. The primary outcome assessed was the incidence of POI. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality.
Sixteen RCTs were included in the systematic review, of which ten (970 patients) were included in the meta-analysis. The incidence of POI was significantly reduced in patients utilising chewing gum compared to those having standard care (RR 0.55, 95% CI 0.39, 0.79, p = 0.0009). These patients also had a significant reduction in time to passage of flatus (WMD - 0.31, 95% CI - 0.36, - 0.26, p < 0.00001) and time to defecation (WMD - 0.47, 95% CI - 0.60, - 0.34, p < 0.00001), without significant differences in the total length of hospital stay or mortality.
The use of chewing gum after colorectal surgery is a safe and effective intervention in reducing the incidence of POI and merits routine use alongside other ERAS pathways in the postoperative setting.
咀嚼口香糖作为一种假性进食的形式，是促进腹部大手术后胃肠道蠕动的一种廉价且耐受良好的方法。尽管咀嚼口香糖已被加速康复外科（ERAS）协会认可为促进手术后恢复的多种方法之一，但缺乏支持其在常规术后实践中使用的有力证据。
在 2000 年至 2019 年间，在 Medline 和 Embase 数据库中对所有随机对照试验（RCT）进行了全面的文献综述。选择这些研究来比较在接受结直肠手术的成年人中，使用口香糖与标准护理治疗术后肠梗阻（POI）的效果。评估的主要结果是 POI 的发生率。次要结果包括肛门排气时间、排便时间、总住院时间和死亡率。
系统评价纳入了 16 项 RCT，其中 10 项（970 例患者）纳入了荟萃分析。与接受标准护理的患者相比，使用口香糖的患者 POI 的发生率显著降低（RR 0.55，95%CI 0.39，0.79，p=0.0009）。这些患者的肛门排气时间（WMD -0.31，95%CI -0.36，-0.26，p<0.00001）和排便时间（WMD -0.47，95%CI -0.60，-0.34，p<0.00001）也有显著缩短，总住院时间或死亡率无显著差异。
结直肠手术后使用口香糖是一种安全有效的干预措施，可降低 POI 的发生率，值得与其他 ERAS 途径一起在术后常规使用。
