Pearl M L, Valea F A, Fischer M, Chalas E
Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook, USA.
Obstet Gynecol. 1996 Sep;88(3):399-402. doi: 10.1016/0029-7844(96)00183-4.
To evaluate the effect of nasogastric decompression after extensive intra-abdominal surgery in gynecologic oncology patients.
Over a 1-year period, 110 gynecologic oncology patients undergoing extensive intra-abdominal surgery were enrolled in a randomized controlled trial of postoperative nasogastric tube versus intra-operative orogastric tube decompression.
The nasogastric and orogastric groups were similar in age, case distribution, surgery length, and blood loss. The nasogastric group had significantly longer times to first passage of flatus and tolerance of a clear liquid diet than did the orogastric group. However, both groups were similar in time to tolerance of a regular diet and hospital stay. On average, the nasogastric tube was maintained for 3.2 +/- 2.1 days (range 1-8) after surgery. The average daily nasogastric output was 440 +/- 283 mL (range 68-1565). No patient in the orogastric group required a nasogastric tube postoperatively, but one patient in the nasogastric group had a nasogastric tube reinserted for recurrent nausea and vomiting. Use of a nasogastric tube led to significantly more subjective complaints, eg, ear pain, painful swallowing, and nasal soreness, but did not significantly reduce the incidence of abdominal distention or nausea and vomiting. Major complications, eg, pneumonia, atelectasis, gastrointestinal bleeding, and wound breakdown or infection, occurred equally in both groups. However, the incidence of febrile morbidity was significantly greater in the nasogastric group. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematological indices and electrolytes were comparable in both groups.
Postoperative nasogastric tube decompression in gynecologic oncology patients undergoing extensive intra-abdominal surgery does not appear to provide any substantial benefit but significantly increases patient discomfort. As a result of this study, we have eliminated postoperative nasogastric decompression except in highly selected circumstances, such as extensive bowel surgery in patients with prior irradiation or substantial edema from bowel obstruction.
评估妇科肿瘤患者广泛腹腔手术后鼻胃管减压的效果。
在1年的时间里，110例接受广泛腹腔手术的妇科肿瘤患者被纳入一项关于术后鼻胃管与术中口胃管减压的随机对照试验。
鼻胃管组和口胃管组在年龄、病例分布、手术时长和失血量方面相似。鼻胃管组首次排气时间和耐受清流食的时间明显长于口胃管组。然而，两组在耐受普食时间和住院时间方面相似。术后鼻胃管平均留置3.2±2.1天（范围1 - 8天）。每日鼻胃管引流量平均为440±283毫升（范围68 - 1565毫升）。口胃管组术后无患者需要留置鼻胃管，但鼻胃管组有1例患者因反复恶心呕吐而重新留置鼻胃管。使用鼻胃管导致更多主观不适，如耳痛、吞咽疼痛和鼻痛，但并未显著降低腹胀、恶心和呕吐的发生率。两组主要并发症，如肺炎、肺不张、胃肠道出血以及伤口裂开或感染的发生率相同。然而，鼻胃管组发热性疾病的发生率明显更高。两组均未发生已知的吻合口并发症或误吸。两组术后血液学指标和电解质变化相当。
接受广泛腹腔手术的妇科肿瘤患者术后鼻胃管减压似乎未带来任何实质性益处，但显著增加了患者不适。基于本研究结果，我们已取消术后鼻胃管减压，除非在高度特定的情况下，如既往接受过放疗的患者进行广泛肠道手术或因肠梗阻出现大量水肿。
