Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA.
Am J Otolaryngol. 2020 May-Jun;41(3):102453. doi: 10.1016/j.amjoto.2020.102453. Epub 2020 Mar 10.
Nasogastric tubes (NGT) are often placed after surgery for cricopharyngeal muscle pathology due to risk of infection and mediastinitis. The aim of this study was to examine if this practice is necessary.
A retrospective case series of subjects who underwent surgery for hypopharyngeal diverticula or cricopharyngeal bars from March 2011 to June 2018 was conducted. Demographic data, type of surgery, placement of feeding tube, initiation of oral feeding, and any complications were recorded.
Sixty-four surgeries were performed for Zenker's diverticula (ZD; N = 52), Killian-Jamieson diverticula (N = 2), and cricopharyngeal bar (N = 10). Mean age and ZD pouch size were 74.0 ± 10.6 years and 3.1 ± 1.8 cm, respectively. Procedures included 48 carbon dioxide laser-assisted myotomies, 14 open diverticulectomies, and 2 endoscopic stapler-assisted diverticulotomies. Of the 64 patients, 19 (29.7%) received intraoperative NGTs while the remaining 45 (70.3%) did not receive NGTs. The former cohort had the NGTs removed on post-operative day (POD) 4.5 ± 2.5, and the non-NGT cohort started clear liquid diet (CLD) on POD 1.2 ± 0.7 days, where 38 patients (84.4%) started CLD on POD 1, and 5 patients (7.8%) were started on oral diet on POD 2-4. Over time, fewer NGTs were placed and oral diets were started sooner. There were 5 complications occurring in 3 patients from the NGT cohort (15.5%) and 2 from the non-NGT cohort (4.4%).
Surgery for hypopharyngeal diverticula and CPB may not require routine perioperative NGT placement which can be associated with higher rates of complication. Patients can safely receive CLD on POD 1.
由于感染和纵隔炎的风险，在环咽肌病理手术后常放置鼻胃管（NGT）。本研究旨在检查这种做法是否必要。
对 2011 年 3 月至 2018 年 6 月间因咽后憩室或环咽肌狭窄而行手术的患者进行回顾性病例系列研究。记录人口统计学数据、手术类型、喂养管放置、开始口服喂养和任何并发症。
共行 64 例手术治疗Zenker 憩室（ZD；N=52）、Killian-Jamieson 憩室（N=2）和环咽肌狭窄（N=10）。平均年龄和 ZD 囊袋大小分别为 74.0±10.6 岁和 3.1±1.8cm。手术方式包括 48 例二氧化碳激光辅助肌切开术、14 例开放性憩室切除术和 2 例内镜吻合器辅助憩室切开术。64 例患者中，19 例（29.7%）术中放置 NGT，其余 45 例（70.3%）未放置 NGT。前者 NGT 于术后第 4.5±2.5 天取出，后者非 NGT 组于术后第 1.2±0.7 天开始清流饮食（CLD），其中 38 例（84.4%）于术后第 1 天开始 CLD，5 例（7.8%）于术后第 2-4 天开始口服饮食。随着时间的推移，放置 NGT 的患者越来越少，开始口服饮食的时间也越来越早。NGT 组有 3 例（15.5%）和非 NGT 组有 2 例（4.4%）共 5 例患者出现并发症。
咽后憩室和环咽肌狭窄的手术可能不需要常规围手术期放置 NGT，因为这可能会导致更高的并发症发生率。患者可在术后第 1 天安全地接受 CLD。
