食管癌术后胃肠减压的必要性评价

林青

[摘要] 目的 評价食管癌术后胃肠减压的必要性。方法 方便收集该院2017年4月—2018年10月食管癌患者142例，所有患者接受食管癌根治手术治疗，对照组食管癌72例患者，观察组食管癌70例患者。两组患者均积极控制基础疾病，行充分的肠道准备，肠道准备方法相同。对照组术后常规留置胃管胃肠减压，术后给予接负压引流袋。观察组术后均未常规放置胃管。分析术后出院天数，比较两组患者的吻合口瘘等并发症发生率，首次出现肠鸣音时间及首次排气时间。置管组患者记录有无咽喉肿痛和急性胃扩展等的相关症状。结果 观察组术后出院天数、首次出现肠鸣音时间及首次排气时间（34.02±0.12）h、（26.02±3.61）h、（18.01±2.02）d与对照组（34.14±0.24）h、（26.15±3.51）h、（18.66±2.59）d差异无统计学意义（t=0.255、1.635、0.821，P>0.05）。两组并发症分析对比显示，观察组术后吻合口瘘、急性胃扩张14例（20.0%）、1例（1.4%）、与对照组18例（25.0%）、2例（2.9%）差异无统计学意义（χ2=0.508、0.370，P>0.05）。观察组术后咽喉部疼痛3例（4.3%）要明显优于对照组10例（13.9%）（χ2=4.370，P<0.05）。结论 食管癌患者术后不行胃肠减压是可行安全的，可有效改善患者的病情，减少并发症的发生，并加速胃肠道功能的恢复，加速患者出院。

[关键词] 食管癌;胃肠减压;必要性

[Abstract] Objective To evaluate the necessity of gastrointestinal decompression after esophageal cancer. Methods A total of 142 patients convenient selection with esophageal cancer from April 2017 to October 2018 in the hospital were collected. All patients underwent radical surgery for esophageal cancer，72 patients with esophageal cancer in the control group，and 70 patients with esophageal cancer in the observation group. Both groups of patients actively controlled the underlying disease and performed adequate bowel preparation，which was performed in the same way. The control group underwent routine decompression of the gastrointestinal gastrointestinal tract and received a negative pressure drainage bag after the operation. No gastric tube was routinely placed in the observation group. The number of postoperative discharge days was analyzed，and the incidence of anastomotic fistula and other complications was compared between the two groups. Patients in the catheterization group recorded symptoms related to sore throat，acute gastric expansion. Results The number of hospital discharge days，the time of first bowel sounds and the time of first exhaustion in the observation group were（34.02 ± 0.12） h，（26.02 ± 3.61）h，（18.01 ± 2.02）d and the control group （34.14 ± 0.24）h，（26.15 ± 3.51）h，（18.66 ± 2.59）d. The difference was not statistically significant（t=0.255，1.635，0.821，P>0.05）. Comparison of the complications between the two groups showed that the observation group had anastomotic fistula，acute gastric dilatation 14 cases（20.0%），1 cases（1.4%），and control group 18 cases（25.0%） and 2 cases（2.8%）. There was no statistically significant difference（χ2=0.508，0.370，P>0.05）. The postoperative throat pain 3 cases（4.3%） in the observation group was significantly better than that in the control group 10 cases（13.9%）（χ2=4.370，P<0.05）. Conclusion It is feasible and safe for patients with esophageal cancer not to perform gastrointestinal decompression after surgery，which can effectively improve the patient's condition，reduce the occurrence of complications，accelerate the recovery of gastrointestinal function，and accelerate the discharge of patients.

[Key words] Esophageal cancer; Gastrointestinal decompression; Necessity

快速康复外科理念是一种新型的手术外科护理理念，其主要价值是在于术前、术中及术后采用相关措施减轻对患者的不良应激反应，加速患者的恢复进程，提高患者满意度的一种措施。而术前不常规放置胃管就是其中一项非常重要的步骤。但是这项措施的安全性仍有争议。该研究方便收集2017年4月—2018年10月食管癌患者142例，所有患者接受食管癌根治手术治疗，对照组食管癌72例患者，观察组食管癌70例患者，目的旨在评价食管癌术后应用胃肠减压的必要性，探讨食管癌术后无需留置胃管胃肠减压的安全性和可行性。现报道如……