食管癌Ivor Lewis术后胃肠减压的随机对照研究  

The necessity of gastrointestinal decompression after Ivor Lewis esophagectomy: A randomized controlled trial

作　　者：喻傲 焦子宸 薛涛[2] 王涛[1] YU Ao;JIAO Zichen;XUE Tao;WANG Tao(Department of Thoracic and Cardiovascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,P.R.China;Department of Thoracic and Cardiovascular Surgery,Southeast University Affiliated Zhongda Hospital,Nanjing,210009,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210008 [2]东南大学附属中大医院心胸外科,南京210009

出　　处：《中国胸心血管外科临床杂志》2018年第10期860-864,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探索食管癌术后不行胃肠减压的可行性和安全性及胃管留置的必要性或拔除时机。方法纳入2017年6~10月在南京鼓楼医院行手术治疗的30例食管癌患者,按1:1随机分配至非胃肠减压组(试验组)和持续胃肠减压组(对照组),每组15例。试验组和对照组年龄(P=1.000)、性别(P=1.000)、肿瘤位置(P=0.732)、组织病理学分型(P=1.000)、术后病理分期(P=0.507)、手术时间(P=0.674)方面差异均无统计学意义。比较两组临床效果。结果两组的吻合口瘘发生率(P=1.000)、吻合口出血发生率(P=1.000)、胃食管反流发生率(P=1.000)、术后第一次排气时间(P=0.629)和术后第一次排便时间(P=0.599)差异均无统计学意义。结论食管癌Ivor Lewis术后不行胃肠减压不会增加吻合口瘘、吻合口出血、胃食管反流的发生率,对胃肠功能的恢复也无明显影响。食管癌Ivor Lewis术后不行胃肠减压是安全可行的,术后第2 d拔除胃管合理可行。Objective To explore the feasibility and safety of non-gastrointestinal decompression after esophagectomy and the necessity of gastric tube or the time to remove gastric tube. Methods Thirty patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, were included in the trial from June to October 2017. The patients were randomly and equally assigned to a trial group （non-gastrointestinal decompression） or a control group （gastrointestinal decompression）. There was no significant difference in age （P=1.000）, sex （P=1.000）, tumor location （P=0.732）, pathological type （P=1.000）, pathological stage （P=0.507）, and operation time （P=0.674） between the two groups. The clinical effect between the two groups were compared. Results There was no statistical difference in incidences of anastomotic leakage （P=1.000）, anastomotic bleeding （P=1.000）, gastroesophageal reflux （P=1.000） between the two groups. And there was no statistical difference in time of the first flatus （P=0.629） and the first bowel movement （P=0.599） after operation between the two groups. Conclusion Without gastrointestinal decompression after Ivor Lewis esophagectomy does not increase the incidences of anastomotic leakage, anastomotic bleeding and gastroesophageal reflux, and has no significant effect on the recovery of gastrointestinal function. Without gastrointestinal decompression after Ivor Lewis esophagectomy is safe and feasible. Removing gastric tube on the second dav after operation is reasonable and feasible.

关 键 词：食管癌 外科手术 胃肠减压 加速康复外科 随机对照研究 

分 类 号：R735.1[医药卫生—肿瘤]