【Abstract】Objective To discuss the clinical significance of postoperative application of gastrointestinal decompression after anastomosis of lower digestive tract. Methods Three hundred and sixty-eight patients undergoing excision and anastomosis of lower digestive tract were divided into two groups: the group with postoperative gastrointestinal decompression and the group without it. The clinical therapeutic outcomes and incidences of complications were compared between the two groups. Results The volume of gastric juice in the decompression group was about 200 ml every day after operation. Both groups had a smaller abdomenal circumference before operation than after operation （P＜0.001）. No difference in the time of first passage of gas from anus and defecation after operation was found between the two groups. The incidence of complications in the decompression group was obviously higher than that of non-decompression group (28.0% vs. 8.2%, P＜0.001); the incidence of pharyngolaryngitis of the former was up to 23.1%. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion The present study shows that application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce the gastrointestinal tract pressure and has no obvious effect on prevention from postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial for the recovery of patients without gastrointestinal decompression.
目的 观察左侧结肠癌伴急性肠梗阻一期手术的疗效，探讨理想的手术治疗方法。方法 回顾性分析四川大学华西医院2007年1月至2009年11月期间收治的46例左侧结肠癌伴急性肠梗阻患者一期手术切除吻合的临床资料。结果 46例均未实施术中结肠灌洗，而行彻底的无污染肠减压法。其中行根治性切除一期吻合35例，姑息性切除一期吻合11例。术后发生吻合口漏3例，切口感染6例，肺部感染2例，盆腔积液1例，均经非手术方法治愈。全组手术无死亡病例。结论 左侧结肠癌伴急性肠梗阻一期切除吻合，用彻底的无污染肠减压法替代结肠灌洗是安全、可行的。
ObjectiveTo investigate clinical outcomes of a new self-made nasogastric tube (NGT) fixation device. MethodsFrom January 2012 to May 2013, 76 consecutive patients with esophageal cancer who underwent esophagectomy by a same surgical group in West China Hospital were included in this study. There were 62 male and 14 female patients with their average age of 60.7 years. Clinical outcomes of the NGT fixation device were prospectively evaluated from the operation day to patients' resumption of oral intake (usually 6 days postoperatively), or the time when NGT fell off accidentally or patients asked to exit this study. The main outcomes included whether NGT fell off, and caused or increased patients' discomfort. ResultsThe operation time of the 76 patients was 192±12 minutes. Postoperatively, 1 patient died of refractory pulmonary infection and respiratory failure before further treatment was refused by the patient and relatives. All the patients completed this study. There was no NGT falling off or severe patients' discomfort. Three patients complained obvious but tolerable face compression with mild discomfort. ConclusionsThis new fixation device can effectively prevent NGT from falling off. Further clinical trial is needed to investigate its clinical value.
ObjectiveTo investigate the feasibility of thoracolapascopic esophagectomy (TLE) without routine nasogastric (NG) intubation for patients with esophageal cancer (EC). MethodsClinical data of 78 EC patients under-going TLE without perioperative NG intubation in Affiliated Cancer Hospital of Zhengzhou University from January to September 2013 were analyzed (non-NG intubation group, including 48 male and 30 female patients with their age of 61.1± 8.5 years). Seventy-eight EC patients undergoing TLE with routine NG intubation for 7 days in 2012 were chosen as the control group (NG intubation group, including 50 male and 28 female patients with their age of 60.3±7.0 years). Operation time, postoperative morbidity, gastrointestinal functional recovery and patient discomfort were compared between the 2 groups. ResultsThere was no in-hospital death in either groups. There was no statistic difference in the incidences of pulmonary infection (16.7% vs. 19.2%, P=0.676), anastomotic leakage (1.3% vs. 2.6%, P=0.560) or NG tube replacement (3.8% vs. 2.6%, P=0.649) between non-NG intubation group and NG intubation group. Time for recovery of intestinal motility (2.5± 1.1 days vs. 4.3±1.2 days, P < 0.05) and time for air evacuation (3.6±1.7 days vs. 5.8±2.1 days, P < 0.05) of non-NG intubation group were significantly shorter than those of NG intubation group. Ninety-seven percent of the patients (76/78)in NG intubation group had uncomfortable feeling including dry mouth and sore throat, and only 6% of the patients (5/78) in non-NG intubation group had nausea. All the patients were followed up for 3 months after discharge. There was no intestinal obstruction, pneumonia or late anastomotic leakage during follow-up. ConclusionTLE without routine NG intubation is safe and feasible for EC patients, which can not only reduce patients' discomfort but also improve early recovery of gastrointestinal function.
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 day after operation is reasonable and feasible.
ObjectiveTo investigate safety and feasibility of laparoscopic common bile duct exploration (LCBDE) without preoperative prophylactic gastrointestinal decompression.MethodsA prospective study was conducted on the patients with choledocholithiasis and cholecystolithiasis scheduled to undergo LCBDE plus laparoscopic cholecystectomy in this hospital from January 2016 to December 2017. All the patients were randomly divided into a gastrointestinal decompression group and a non-gastrointestinal decompression group by the same researcher according to the random number table method. The general conditions, intraoperative status and postoperative status of patients in the two groups were compared.ResultsA total of 286 patients were enrolled in this study, including 120 in the non-gastrointestinal decompression group and 166 in the gastrointestinal decompression group. There were no significant differences in the general data such as the age, gender, smoking history, drinking history, preoperative complications, results of preoperative laboratory examination, and preoperative anesthesia score between the two groups (P>0.050). The time of oral feeding in the non-gastrointestinal decompression group was significantly earlier than that in the gastrointestinal decompression group (t=2.181, P=0.030). There were no significant differences in the bleeding volume, operative time, anal ventilation time, total hospitalization time, and postoperative hospitalization time between the two groups (P>0.050). The incidences of nausea/vomiting and poor appetite in the non-gastrointestinal decompression were significantly lower than those in the gastrointestinal decompression group (χ2=5.098, P=0.024; χ2=4.905, P=0.027). There were no significant differences in the incidences of other complications between the two groups (P>0.050).ConclusionFrom results of this study, prophylactic gastrointestinal decompression should not be recommended for patients undergoing LCBDE.