Chusilp Sinobol, Yamoto Masaya, Vejchapipat Paisarn, Ganji Niloofar, Pierro Agostino
Division of General and Thoracic Surgery, Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Pediatr Surg Int. 2021 Mar;37(3):377-388. doi: 10.1007/s00383-020-04818-6. Epub 2021 Feb 10.
Postoperative nasogastric decompression has been routinely used after intestinal surgery. However, the role of nasogastric decompression in preventing postoperative complications and promoting the recovery of bowel function in children remains controversial. This systematic review aimed to assess whether routine nasogastric decompression is necessary after intestinal surgery in children.
A systematic review was conducted following the PRISMA guideline. Literature search was performed in electronic databases including PubMed, Embase, CENTRAL, and Web of science. Studies comparing outcomes between children who underwent intestinal surgery with postoperative nasogastric tube (NGT) placement (NGT group) and without postoperative NGT placement (no NGT group) were included.
Six studies were eligible for inclusion criteria including two randomized controlled trials (RCT) and four comparative observational studies. The overall rate of postoperative anastomotic leak was 0.6% (1/179) in NGT group and 0.9% (2/223) in no NGT group. The overall rate of wound dehiscence was 2.4% (4/169) in NGT group and 1.6% (4/245) in no NGT group. Meta-analysis of two RCTs in children undergoing elective intestinal surgery showed significant increase of mild vomiting in no NGT group compared with NGT group (OR 3.54 95% CI 1.04, 11.99) but no significant difference in persistent vomiting requiring NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), abdominal distension (OR 2.36 95% CI 0.34, 16.59), NGT reinsertion (OR 3.11 95% CI 0.47, 20.54), wound infection (OR 1.63 95% CI 0.49, 5.48) and time to return of bowel movement (MD - 0.14 95% CI - 0.45, 0.17). There was no incidence of anastomotic leak in these 2 RCTs. However, there was an incidence of NGT-related discomfort in NGT group, which ranged from 30 to 100% of children studied.
Routine postoperative nasogastric decompression can be omitted in children undergoing intestinal surgery due to no benefit in preventing postoperative complications while increasing patient discomfort.
术后鼻胃减压在肠道手术后一直被常规使用。然而，鼻胃减压在预防儿童术后并发症和促进肠功能恢复方面的作用仍存在争议。本系统评价旨在评估儿童肠道手术后常规鼻胃减压是否必要。
按照PRISMA指南进行系统评价。在包括PubMed、Embase、CENTRAL和Web of science在内的电子数据库中进行文献检索。纳入比较接受肠道手术并放置术后鼻胃管（鼻胃管组）与未放置术后鼻胃管（无鼻胃管组）的儿童结局的研究。
六项研究符合纳入标准，包括两项随机对照试验（RCT）和四项比较观察性研究。鼻胃管组术后吻合口漏的总体发生率为0.6%（1/179），无鼻胃管组为0.9%（2/223）。鼻胃管组伤口裂开的总体发生率为2.4%（4/169），无鼻胃管组为1.6%（4/245）。对两项接受择期肠道手术儿童的RCT进行的荟萃分析显示，无鼻胃管组轻度呕吐的发生率显著高于鼻胃管组（OR 3.54，95%CI 1.04，11.99），但在需要重新插入鼻胃管的持续性呕吐（OR 3.11，95%CI 0.47，20.54）、腹胀（OR 2.36，95%CI 0.34，16.59）、重新插入鼻胃管（OR 3.11，95%CI 0.47，20.54）、伤口感染（OR 1.63，95%CI 0.49，5.48）和恢复排便时间（MD -0.14，95%CI -0.45，0.17）方面无显著差异。这两项RCT中均无吻合口漏的发生。然而鼻胃管组存在鼻胃管相关不适的发生率，在所研究儿童中占30%至100%。
由于常规术后鼻胃减压对预防术后并发症无益处，同时增加患者不适，因此在接受肠道手术的儿童中可省略。
