CAJ | 학술논문

目的评价胃切除术后留置胃肠减压的必要性.方法以Medline、Embase、the Cochrane Library数据库作为已发表国外文献的主要来源,以万方数据知识服务平台和中国知网数据出版平台作为已发表国内文献的主要来源;检索时间:2011年4月20日.收集1990-2011年公开发表的有关胃切除术后放置胃肠减压必要性的中文和英文文献.结果筛选出符合纳入标准的前瞻性随机对照试验8项(975例).减压组和非减压组在术后排气时间相比差异无统计学意义(WMD=0.31,95%CI:-0.07～0.69,P＞0.05),而在进食时间和住院时间相比差异有统计学意义(WMD=0.61,95%CI:0.17～1.05,P＜0.05;WMD=1.20,95%CI:0.05～2.36,P＜0.05),非减压组的进食时间、住院时间短于减压组;减压组和非减压组发热的发生率之间相比差异有统计学意义(OR=1.76,95%CI:1.11～2.78,P＜0.05),减压组的发热发生率高于非减压组;其他并发症包括恶心、呕吐、肺部感染、吻合口瘘或十二指肠残端瘘、腹腔脓肿、切口裂开的发生率之间相比差异均无统计学意义(OR=1.43,95%CI:0.61～3.31,P＞0.05;OR=1.43,95%CI:0.82～2.49,P＞0.05;OR=1.17,95%CI:0.54～2.49,P＞0.05;OR=1.08,95%CI:0.50～2.34,P＞0.05;OR=1.47,95%CI:0.43～4.95,P＞0.05).结论胃切除术后常规留置胃肠减压并不能加快胃肠功能的恢复,不能减少手术后并发症的发生,甚至增加术后发热的发生率,延长住院周期.
목적 평개위절제술후류치위장감압적필요성.방법 이Medline、Embase、the Cochrane Library수거고작위이발표국외문헌적주요래원,이만방수거지식복무평태화중국지망수거출판평태작위이발표국내문헌적주요래원;검색시간:2011년4월20일.수집1990-2011년공개발표적유관위절제술후방치위장감압필요성적중문화영문문헌.결과 사선출부합납입표준적전첨성수궤대조시험8항(975례).감압조화비감압조재술후배기시간상비차이무통계학의의(WMD=0.31,95%CI:-0.07～0.69,P＞0.05),이재진식시간화주원시간상비차이유통계학의의(WMD=0.61,95%CI:0.17～1.05,P＜0.05;WMD=1.20,95%CI:0.05～2.36,P＜0.05),비감압조적진식시간、주원시간단우감압조;감압조화비감압조발열적발생솔지간상비차이유통계학의의(OR=1.76,95%CI:1.11～2.78,P＜0.05),감압조적발열발생솔고우비감압조;기타병발증포괄악심、구토、폐부감염、문합구루혹십이지장잔단루、복강농종、절구렬개적발생솔지간상비차이균무통계학의의(OR=1.43,95%CI:0.61～3.31,P＞0.05;OR=1.43,95%CI:0.82～2.49,P＞0.05;OR=1.17,95%CI:0.54～2.49,P＞0.05;OR=1.08,95%CI:0.50～2.34,P＞0.05;OR=1.47,95%CI:0.43～4.95,P＞0.05).결론 위절제술후상규류치위장감압병불능가쾌위장공능적회복,불능감소수술후병발증적발생,심지증가술후발열적발생솔,연장주원주기.
Objective To evaluate the necessity of indwelling gastrointestinal decompression after gastrectomy. Methods Eight publications on the necessity of gastrointestinal decompression after gastrecomy were colleted, data on recovery time of gastrointestinal function and hospital stay, complications,and motality were Meta-analyzed using fixed effect model and random effect model. Results Eight randomized trails including 975 patients were qualified and included in this study. The differences in time to oral intake ( WMD =0. 61, 95% CI: 0. 17 - 1.05, P ＜ 0. 05 ) and hospital stay ( WMD = 1.20, 95% CI:0. 05 -2. 36, P ＜ 0. 05 ) between the decompression group and non-decompression group were statistically significant, but the difference in time to flatus (WMD = 0. 31,95% CI: -0. 07- 0. 69, P ＞ 0. 05 ) was not significant. There were no significant differences in complications such as nausea and vomiting ( OR = 1.43,95% CI: 0. 61 - 3.31, P ＞ 0. 05 ), pulmonary infection and atelectasis ( OR = 1.43, 95 % CI: 0. 82 - 2. 49,P＞0.05), anastomotic leakage (OR = 1.17, 95%CI: 0.54-2.49, P ＞0.05), abdominal abscess ( OR = 1.08, 95% CI: 0. 50 - 2. 34, P ＞ 0. 05 ), wound dehiscence ( OR = 1.47, 95% CI: 0. 43 - 4. 95,P ＞ 0. 05 ) between the two groups, except for fever ( OR = 1.76, 95% CI: 1.11 - 2. 78, P ＜ 0. 05 ), which was found more frequent in decompression group than in non-decompression group. Conclusions Routine gastrointestinal decompression after gastrectomy was not conductive to the recovery of gastrointestinal function, and could not reduce the incidence of postoperative complications. Postoperative GI decompression increased fever incidence rate and prolonged hospital stay.