Evaluation Of Clinical Necessity Of Gastric Catheter Indwelling Afterexcision And Anastomosis Of The Colon And Rectum

Objective:Fast track surgery theory is advocated by Henrik Kehlet in2001, and is gradually being taken seriously by surgical clinicians. Its main value is the use of a series of optimized and really effective treatment measures to shorten hospitalization periods, reducing perioperative physical and psychological trauma, stress and complications in the preoperative、intraoperative and postoperative period. It also can accelerate postoperative rehabilitation, reduce the patient’s pain, and shorten hospital stays. The placement of the routine nasogastric tube preoperative and early postoperative oral feeding are very important steps. However, the safety of this measure remains controversial. The purpose of this article is to explore the security and feasibility of none-routine application of the nasogastric decompression tube during perioperative period of rectocolonic diseases, thus help to alleviate patients’ pain.Methods:Three hundred and sixty patients receiving excision and anastomosis of the colon and rectum in Qilu Hospital of Shandong University from January2011to December2012were retrospectively studied.1. Exclusion criteria:①patients with a history of preoperative gastrointestinal obstruction.②patients without resection and anastomosis in gastrointestinal surgery.③patients receiving prophylactic colostomy.2.Grouping method:210patients who were inserted nasogastric decompression tube during operative period as control group, meanwhile other150patients with none routine nasogastric decompression tube and early oral feeding as the observation group. The two groups were offered the same intestinal preparation.3.Outcome measures:The comparison of clinical therapeutic outcomes (the volume of gastric juice, the lengths of the first anal flatus and stool, the hospital stay after operation) and incidences of complications (nausea and vomiting, abdominal distension, atelectasis, laryngopharyngeal pain, pulmonary infection, anastomotic leakage, wound infection) were made between the two groups.Results:There is no deaths in routine decompression group, while one in non-routine decompression group. It’s considered to be caused by abdominal infection secondary to anastomotic fistula. He dies of multiple organ failure after transferred to ICU.1. The volume of gastric juice in the routine decompression group was no more than400ml every day after operation.2. The lengths of the first anal flatus and stool after operation were not found to present statistical differences between two groups.3. The differences in the incidence of complications such as abdominal distension, atelectasis, pulmonary infection, anastomotic leakage, wound infection had no statistical significance (P>0.05), while the ratio of nausea and vomiting, throat ache in control group increased significantly (P<0.05).4. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion:1. Gastric catheter indwelling after excision and anastomosis of the colon and rectum cannot effectively reduce the intestinal tract pressure and facilitate the recovery of the gastrointestinal function2. It also cannot prevent patients from postoperative complications such as abdominal distension, atelectasis, pulmonary infection, anastomotic leakage, wound infection. On the contrary, it may involve a greater ratio of incidence of nausea and vomiting, throat ache.3. For most patients, none routine nasogastric decompression tube can alleviate the patient’s pain, and is safer and more feasibility for them.4. We cannot completely negate the value of nasogastric tube in colorectal surgery. The use of the tube should be based on patient’s clinical situation, for example, patients with a history of preoperative bowel obstruction or a history of previous abdominal surgery, or preoperative poor general condition.5. Fast track surgery optimizes clinical care, but some theories are still controversial, even in foreign countries it is not widely accepted. We cannot just listen.