术中鼻空肠管置入与腹腔镜胰十二指肠切除术后胃排空延迟的相关性分析

Association between intraoperative nasojejunal tube placement and delayed gastric emptying after laparoscopic pancreaticoduodenectomy

摘要:

背景与目的 腹腔镜胰十二指肠切除术（LPD）是治疗壶腹部周围肿瘤的重要手术方式，但术后胃排空延迟（DGE）仍较为常见，严重影响患者恢复。鼻空肠管（NJT）常用于术后早期肠内营养支持，但其对DGE的影响尚存争议。本研究旨在探讨术中置入NJT与LPD术后DGE发生的相关性，并评估其对术后恢复及预后的影响。方法 回顾性分析2017年4月—2023年11月于山东第一医科大学附属省立医院接受LPD的319例患者的病历资料，按术中是否放置NJT分为NJT组（n=200）与无NJT组（n=119）。比较两组DGE发生率及术后恢复指标差异。采用多因素Logistic回归及倾向性评分匹配（PSM）分析，验证NJT置入是否为DGE的独立危险因素。结果 NJT组B、C级DGE发生率明显高于无NJT组（36.5% vs. 21.8%，P=0.006），术后住院时间和住院费用亦明显增加（均P<0.05）。多因素分析显示，术中置入NJT（OR=1.960，95% CI=1.142~3.363，P=0.015）及术中出血量>400 mL（OR=1.921，95% CI=1.155~3.194，P=0.012）为DGE的独立危险因素。PSM后结果仍保持一致。结论 术中预防性放置NJT不仅不能改善患者术后恢复，反而显著增加DGE风险并延长住院时间、增加医疗费用。临床上应避免常规放置NJT，而应依据患者具体情况进行个体化决策，以减少术后并发症并优化恢复过程。

Abstract:

Background and Aims Laparoscopic pancreaticoduodenectomy (LPD) has become a preferred approach for periampullary tumors, yet delayed gastric emptying (DGE) remains a frequent complication that hampers postoperative recovery. The nasojejunal feeding tube (NJT) is commonly used for early enteral nutrition, but its impact on DGE is controversial. This study aimed to evaluate whether intraoperative NJT placement increases the risk of DGE after LPD and to assess its influence on postoperative recovery outcomes.Methods A retrospective cohort of 319 patients who underwent LPD at Provincial Hospital Affiliated to Shandong First Medical University from April 2017 to November 2023 was analyzed. Patients were divided into two groups based on intraoperative NJT placement (NJT group, n=200; non-NJT group, n=119). The incidence of DGE and postoperative outcomes were compared. Multivariate logistic regression and propensity score matching (PSM) were performed to identify independent risk factors for DGE.Results The incidence of grade B/C DGE was significantly higher in the NJT group than in the non-NJT group (36.5% vs. 21.8%, P=0.006). NJT placement was associated with longer postoperative hospital stay and higher hospitalization costs (both P<0.05). Multivariate analysis revealed intraoperative NJT placement (OR=1.960, 95% CI=1.142-3.363, P=0.015) and intraoperative blood loss >400 mL (OR=1.921, 95% CI=1.155-3.194, P=0.012) as independent risk factors for DGE. These findings were consistent after PSM.Conclusions Prophylactic intraoperative NJT placement confers no additional benefit for postoperative recovery after LPD and is associated with a higher risk of DGE, prolonged hospitalization, and increased medical costs. Routine NJT placement should therefore be avoided, and individualized strategies should be adopted to minimize postoperative complications and enhance recovery