Gao Jia, Liu Xinchun, Wang Haoran, Ying Rongchao
Department of General Surgery, The Affiliated Hangzhou Hospital of Nanjing Medical University, Huansha Road 261, Hangzhou, 310000, Zhejiang Province, China.
Department of General Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine, Huansha Road 261, Hangzhou, 310000, Zhejiang Province, China.
BMC Gastroenterol. 2020 Apr 25;20(1):126. doi: 10.1186/s12876-020-01265-4.
Gastric decompression after pancreatic surgery has been a routine procedure for many years. However, this procedure has often been waived in non-pancreatic abdominal surgeries. The aim of this meta-analysis was to determine the necessity of routine gastric decompression (RGD) following pancreatic surgery.
PubMed, the Cochrane Library, EMBASE, and Web of Science were systematically searched to identify relevant studies comparing outcomes of RGD and no gastric decompression (NGD) after pancreatic surgery. The overall complications, major complications, mortality, delayed gastric emptying (DGE); clinically relevant DGE (CR-DGE), postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), secondary gastric decompression, and the length of hospital stay were evaluated.
A total of six comparative studies with a total of 940 patients were included. There were no differences between RGD and NGD groups in terms of the overall complications (OR = 1.73, 95% CI: 0.60-5.00; p = 0.31), major complications (OR = 2.22, 95% CI: 1.00-4.91; p = 0.05), incidence of secondary gastric decompression (OR = 1.19, 95% CI: 0.60-2.02; p = 0.61), incidence of overall DGE (OR = 2.74; 95% CI: 0.88-8.56; p = 0.08; I = 88%), incidence of CR-POPF (OR = 1.28, 95% CI: 0.76-2.15; p = 0.36), and incidence of POPF (OR = 1.31, 95% CI: 0.81-2.14; p = 0.27). However, RGD was associated with a higher incidence of CR-DGE (OR = 5.45; 95% CI: 2.68-11.09; p < 0.001, I = 35%), a higher rate of mortality (OR = 1.53; 95% CI: 1.05-2.24; p = 0.03; I = 83%), and a longer length of hospital stay (WMD = 5.43, 95% CI: 0.30 to 10.56; p = 0.04; I = 93%).
Routine gastric decompression in patients after pancreatic surgery was not associated with a better recovery, and may be unnecessary after pancreatic surgery.
多年来，胰腺手术后进行胃减压一直是常规操作。然而，在非胰腺腹部手术中，这一操作常常被省略。本荟萃分析的目的是确定胰腺手术后常规胃减压（RGD）的必要性。
系统检索了PubMed、Cochrane图书馆、EMBASE和科学网，以识别比较胰腺手术后RGD与不进行胃减压（NGD）的相关研究。评估了总体并发症、主要并发症、死亡率、胃排空延迟（DGE）；临床相关DGE（CR-DGE）、术后胰瘘（POPF）、临床相关POPF（CR-POPF）、二次胃减压以及住院时间。
共纳入6项比较研究，总计940例患者。RGD组和NGD组在总体并发症（OR = 1.73，95% CI：0.60 - 5.00；p = 0.31）、主要并发症（OR = 2.22，95% CI：1.00 - 4.91；p = 0.05）、二次胃减压发生率（OR = 1.19，95% CI：0.60 - 2.02；p = 0.61）、总体DGE发生率（OR = 2.74；95% CI：0.88 - 8.56；p = 0.08；I² = 88%）、CR-POPF发生率（OR = 1.28，95% CI：0.76 - 2.15；p = 0.36）和POPF发生率（OR = 1.31，95% CI：0.81 - 2.14；p = 0.27）方面无差异。然而，RGD与CR-DGE的较高发生率（OR = 5.45；95% CI：2.68 - 11.09；p < 0.001，I² = 35%）、较高的死亡率（OR = 1.53；95% CI：1.05 - 2.24；p = 0.03；I² = 83%）以及较长的住院时间（WMD = 5.43，95% CI：0.30至10.56；p = 0.04；I² = 93%）相关。
胰腺手术后患者进行常规胃减压与更好的恢复无关，胰腺手术后可能没有必要进行。
