Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN, USA.
Walther Oncology Center, Indianapolis, IN, USA.
J Gastrointest Surg. 2021 Nov;25(11):2902-2907. doi: 10.1007/s11605-021-04971-w. Epub 2021 Mar 26.
The decision to routinely leave a nasogastric tube after pancreatoduodenectomy remains controversial. We sought to determine the impact of immediate nasogastric tube removal versus early nasogastric tube removal (<24 h) on postoperative outcomes.
A retrospective review of our institution's prospective ACS-NSQIP database identified patients that underwent pancreatoduodenectomy from 2015 to 2018. Outcomes were compared among patients with immediate nasogastric tube removal versus early nasogastric tube removal.
A total of 365 patients were included in primary analysis (no nasogastric tube, n = 99; nasogastric tube removed <24 h, n = 266). Thirty-day mortality and infectious, renal, cardiovascular, and pulmonary morbidity were similar in comparing those with no nasogastric tube versus early nasogastric tube removal on univariable and multivariable analyses (P > 0.05). Incidence of delayed gastric emptying (11.1 versus 13.2%) was similar between groups. Patients with no nasogastric tube less frequently required nasogastric tube reinsertion (n = 4, 4%) compared to patients with NGT <24 h (n = 39, 15%) (OR = 3.83, 95% CI [1.39-10.58]; P = 0.009).
Routine gastric decompression can be safely avoided after uneventful pancreaticoduodenectomy.
在胰十二指肠切除术后常规留置鼻胃管仍存在争议。我们旨在确定即刻拔除与早期（<24 小时）拔除鼻胃管对术后结果的影响。
回顾性分析我院前瞻性 ACS-NSQIP 数据库中 2015 年至 2018 年间接受胰十二指肠切除术的患者。比较即刻拔除鼻胃管与早期（<24 小时）拔除鼻胃管患者的术后结果。
共纳入 365 例患者进行主要分析（未留置鼻胃管，n = 99；鼻胃管在 24 小时内拔除，n = 266）。在单变量和多变量分析中，比较无鼻胃管组与早期鼻胃管组，30 天死亡率以及感染、肾脏、心血管和肺部并发症无显著差异（P > 0.05）。两组间延迟性胃排空的发生率（11.1%与 13.2%）相似。无鼻胃管组患者需要再次插入鼻胃管的比例（4%，n = 4）明显低于早期（<24 小时）拔除鼻胃管组（15%，n = 39）（OR = 3.83，95% CI [1.39-10.58]；P = 0.009）。
在无并发症的胰十二指肠切除术后，可安全避免常规胃肠减压。
