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目的探讨结直肠肿瘤择期手术后应用鼻胃管胃肠减压的有效性和安全性。方法全面检索国内外公开发表的评价结直肠肿瘤择期手术后鼻胃管胃肠减压的随机对照试验(RCTs)文献,根据标准纳入文献,提取临床指标,进行meta分析。结果最终纳入6项RCTs(736例),大部分试验的病例组特征上具有可比性。非鼻胃管胃肠减压(non-NGD)组较鼻胃管胃肠减压(NGD)组胃肠功能恢复时间短[加权均数差WMD=-1.15,95%CI(-1.87～-0.43),P=0.002],住院时间少[WMD=-2.43,95%CI(-3.75～-1.10),P=0.000 3],虽呕吐发生多[RR=2.12,95%CI(1.19～3.78),P=0.01],但肺部感染发生少[RR=0.17,95%CI(0.03～0.95),P=0.04]。两组发生伤口感染[RR=0.76,95%CI(0.29～1.99),P=0.58]和鼻胃管再置[RR=1.85,95%CI(0.89～3.88),P=0.10]差异无统计学意义。结论结直肠肿瘤手术后不应用鼻胃管是安全的,常规应用鼻胃管并不能给患者带来更多益处,反而会增加并发症(如肺部感染)的发生。
Objective To investigate the effectiveness and safety of nasogastric tube decompression after elective surgery in colorectal tumors. Methods All published literatures published at home and abroad on randomized controlled trials (RCTs) for evaluating the gastrointestinal decompression of colorectal neoplasms after elective surgery of colorectal cancer were included in the literature. The clinical data were extracted and the meta-analysis was performed. The results eventually included six RCTs (736 cases), most of the trials were comparable in case characteristics. The recovery time of gastrointestinal function in non-NGD group was shorter than that in NGD group [weighted mean difference WMD = -1.15,95% CI -1.87 ~ - (RR = 2.12, 95% CI, 1.19-3.78, P = 0.002), less hospital stay [WMD = -2.43,95% CI -3.75-1.10, P = 0.0003] ), P = 0.01], but fewer pulmonary infections occurred [RR = 0.17, 95% CI (0.03-0.95), P = 0.04]. There was no statistical difference in wound infection between the two groups (RR = 0.76, 95% CI 0.29 to 1.99, P 0.58) and nasogastric relocation (RR 1.85, 95% CI 0.89 to 3.88) Significance of learning. Conclusion The application of nasogastric tube after colorectal cancer surgery is safe. Conventional application of nasogastric tube does not bring more benefits to patients, but will increase the incidence of complications such as pulmonary infection.