胆囊切除术围手术期免放胃管的体会
陈静, 张德巍, 中国医科大学附属第四医院普通外科 辽宁省沈阳市 110005
通讯作者:陈静, 110005, 辽宁省沈阳市和平区南七马路102号, 中国医科大学附属第四医院普通外科.
电话: 024-23390457
收稿日期: 2005-02-14 接受日期: 2005-03-03
摘要
目的:探讨胆囊切除术胃管应用的必要性和合理性.
方法:回顾性分析1995-07/2004-11胆囊切除术124例，分为置胃管组64例，未置胃管组60例，置胃管组术前常规放置胃管，未置胃管组术前不放置胃管，观察两组对术后并发症、术后肛门排气时间、进半流食时间及离床活动时间的影响.
, http://www.100md.com
结果:两组均无切口裂开、肺部感染并发症.置胃管组与未置胃管组相比术后腹胀、呕吐、切口感染无明显差异(P>0.05)，术后肛门排气时间及进半流食时间无明显差异(P>0.05)，恶心明显增多(14vs 5，c2= 4.428，P = 0.028)，离床活动时间明显延迟(3.11±0.75 d vs 1.53±0.34 d，t= 3.994，P= 0.0005).置胃管组咽喉疼痛、声嘶明显增多，未置胃管组无此并发症.
结论:胆囊切除术前不下胃管并不能增加术后并发症，不影响术后胃肠功能恢复，因此安全可行.
陈静, 张德巍. 胆囊切除术围手术期免放胃管的体会. 世界华人消化杂志 2005;13(9):1158-1159
Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery withversus without nasogastric decompression.
, http://www.100md.com
Yonsei Med J 2002;43:451-456
3 Inman BA, Harel F, Tiguert R, Lacombe L, Fraset Y. Routinenasogastric tubes are not required following cystectomy
with urinary diversion:a comparativeanalysis of 430 patients. J Urol 2003;170:1888-1891
4 Huerta S, Arteaga JR, Sawicki MP, Liu CD, Livingston EH. Assessmentof routine elimination of postoperative
nasogastric decompression afterRoux-en-Y gastric bypass. Surgery 2002;132:844-848
, http://www.100md.com
5 Sands DR, Wexner SD. Nasogastric tubes and dietary advancementafter laparoscopic and open colorectal surgery.
Nutrition 1999;15:347-350
6 张连新. 择期剖腹手术后免插胃管的临床研究. 中国医师杂志 2002;4:23-24
7 Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is notnecessary in operations for gastric
cancer:prospective randomised trial.Eur J Surg 2002;168:379-383
, 百拇医药
8 Akbaba S, Kayaalp C, Savkilioglu M. Nasogastric decompression aftertotal gastrectomy.
Hepatogastroenterology 2004;51:1881-1885
9 Nelson R, EdwardsS, Tse B. Prophylactic nasogastric decompression after abdominal surgery.
Cochrane Database Syst Rev 2005;25:CD004929
10 Feo CV, Romanini B, Sortini D, Ragazzi R, Zamboni P, Pansini GC,Liboni A. Early oral feeding after colorectal
, 百拇医药
resection:a randomizedcontrolled study. ANZ J Surg 2004;74:298-301
11 Gouzi JL, Moran B. Nasogastric tubes after elective abdominalsurgery is not justified. J Chir (Paris) 1998;135:273-274
12 Manning BJ, Winter DC, McGreal G, Kirwan WO, Redmond HP.Nasogastric intubation causes gastroesophageal reflux
in patients undergoingelective laparotomy. Surgery 2001;130:788-791
, 百拇医药
13 Schwartz CI, Heyman AS, Rao AC. Prophylactic nasogastric tubedecompression:is its use justified?
South Med J 1995;88:825-830
14 Nathan BN, Pain JA. Nasogastric suction after elective abdominalsurgery: a randomised study.
Ann R Coll Surg Engl 1991;73:291-294
15 Chung HY, Yu W. Reevaluation of routine gastrointestinaldecompression after gastrectomy for gastric cancer.
Hepatogastroenterology 2003;50:1190-1192
编辑 张海宁, 百拇医药( 陈 静,张德巍)
通讯作者:陈静, 110005, 辽宁省沈阳市和平区南七马路102号, 中国医科大学附属第四医院普通外科.
电话: 024-23390457
收稿日期: 2005-02-14 接受日期: 2005-03-03
摘要
目的:探讨胆囊切除术胃管应用的必要性和合理性.
方法:回顾性分析1995-07/2004-11胆囊切除术124例，分为置胃管组64例，未置胃管组60例，置胃管组术前常规放置胃管，未置胃管组术前不放置胃管，观察两组对术后并发症、术后肛门排气时间、进半流食时间及离床活动时间的影响.
, http://www.100md.com
结果:两组均无切口裂开、肺部感染并发症.置胃管组与未置胃管组相比术后腹胀、呕吐、切口感染无明显差异(P>0.05)，术后肛门排气时间及进半流食时间无明显差异(P>0.05)，恶心明显增多(14vs 5，c2= 4.428，P = 0.028)，离床活动时间明显延迟(3.11±0.75 d vs 1.53±0.34 d，t= 3.994，P= 0.0005).置胃管组咽喉疼痛、声嘶明显增多，未置胃管组无此并发症.
结论:胆囊切除术前不下胃管并不能增加术后并发症，不影响术后胃肠功能恢复，因此安全可行.
陈静, 张德巍. 胆囊切除术围手术期免放胃管的体会. 世界华人消化杂志 2005;13(9):1158-1159
Lee JH, Hyung WJ, Noh SH. Comparison of gastric cancer surgery withversus without nasogastric decompression.
, http://www.100md.com
Yonsei Med J 2002;43:451-456
3 Inman BA, Harel F, Tiguert R, Lacombe L, Fraset Y. Routinenasogastric tubes are not required following cystectomy
with urinary diversion:a comparativeanalysis of 430 patients. J Urol 2003;170:1888-1891
4 Huerta S, Arteaga JR, Sawicki MP, Liu CD, Livingston EH. Assessmentof routine elimination of postoperative
nasogastric decompression afterRoux-en-Y gastric bypass. Surgery 2002;132:844-848
, http://www.100md.com
5 Sands DR, Wexner SD. Nasogastric tubes and dietary advancementafter laparoscopic and open colorectal surgery.
Nutrition 1999;15:347-350
6 张连新. 择期剖腹手术后免插胃管的临床研究. 中国医师杂志 2002;4:23-24
7 Yoo CH, Son BH, Han WK, Pae WK. Nasogastric decompression is notnecessary in operations for gastric
cancer:prospective randomised trial.Eur J Surg 2002;168:379-383
, 百拇医药
8 Akbaba S, Kayaalp C, Savkilioglu M. Nasogastric decompression aftertotal gastrectomy.
Hepatogastroenterology 2004;51:1881-1885
9 Nelson R, EdwardsS, Tse B. Prophylactic nasogastric decompression after abdominal surgery.
Cochrane Database Syst Rev 2005;25:CD004929
10 Feo CV, Romanini B, Sortini D, Ragazzi R, Zamboni P, Pansini GC,Liboni A. Early oral feeding after colorectal
, 百拇医药
resection:a randomizedcontrolled study. ANZ J Surg 2004;74:298-301
11 Gouzi JL, Moran B. Nasogastric tubes after elective abdominalsurgery is not justified. J Chir (Paris) 1998;135:273-274
12 Manning BJ, Winter DC, McGreal G, Kirwan WO, Redmond HP.Nasogastric intubation causes gastroesophageal reflux
in patients undergoingelective laparotomy. Surgery 2001;130:788-791
, 百拇医药
13 Schwartz CI, Heyman AS, Rao AC. Prophylactic nasogastric tubedecompression:is its use justified?
South Med J 1995;88:825-830
14 Nathan BN, Pain JA. Nasogastric suction after elective abdominalsurgery: a randomised study.
Ann R Coll Surg Engl 1991;73:291-294
15 Chung HY, Yu W. Reevaluation of routine gastrointestinaldecompression after gastrectomy for gastric cancer.
Hepatogastroenterology 2003;50:1190-1192
编辑 张海宁, 百拇医药( 陈 静,张德巍)
