术后鼻胃 (NG) 减压:有高质量的证据表明常规术后鼻胃减压并无益处,应作为可选方案使用。[71]Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev. 2007;(3):CD004929.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004929.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17636780?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
术后鼻胃 (NG) 减压:有高质量的证据表明常规术后鼻胃减压并无益处,应作为可选方案使用。[71]Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev. 2007;(3):CD004929.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004929.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17636780?tool=bestpractice.com
术后肠梗阻持续时间:有中等质量证据表明相对于剖腹手术,腹腔镜检查与缩短住院治疗时间有关。相对于剖腹手术,有些研究将腹腔镜手术和肠道功能恢复时间的缩短明确地联系在一起。[16]Tjandra JJ, Chan MK. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis. 2006;8:375-388.http://www.ncbi.nlm.nih.gov/pubmed/16684081?tool=bestpractice.com[17]Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477-484.http://www.ncbi.nlm.nih.gov/pubmed/15992696?tool=bestpractice.com[18]Tilney HS, Lovegrove RE, Purkayastha S, et al. Laparoscopic vs open subtotal colectomy for benign and malignant disease. Colorectal Dis. 2006;8:441-450.http://www.ncbi.nlm.nih.gov/pubmed/16684090?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
术后肠梗阻持续时间:有中等质量证据表明相对于剖腹手术,腹腔镜检查与缩短住院治疗时间有关。相对于剖腹手术,有些研究将腹腔镜手术和肠道功能恢复时间的缩短明确地联系在一起。[16]Tjandra JJ, Chan MK. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis. 2006;8:375-388.http://www.ncbi.nlm.nih.gov/pubmed/16684081?tool=bestpractice.com[17]Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477-484.http://www.ncbi.nlm.nih.gov/pubmed/15992696?tool=bestpractice.com[18]Tilney HS, Lovegrove RE, Purkayastha S, et al. Laparoscopic vs open subtotal colectomy for benign and malignant disease. Colorectal Dis. 2006;8:441-450.http://www.ncbi.nlm.nih.gov/pubmed/16684090?tool=bestpractice.com
早期术后喂食耐受性:有中等质量的证据表明早起术后喂食有相当好的耐受性。[21]Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg. 1995;222:73-77.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=7618972http://www.ncbi.nlm.nih.gov/pubmed/7618972?tool=bestpractice.com[22]Feo CV, Romanini B, Sortini D, et al. Early oral feeding after colorectal resection: a randomized controlled study. ANZ J Surg. 2004;74:298-301.http://www.ncbi.nlm.nih.gov/pubmed/15144242?tool=bestpractice.com[23]Stewart BT, Woods RJ, Collopy BT, et al. Early feeding after elective open colorectal resections: a prospective randomized trial. Aust N Z J Surg. 1998;68:125-128.http://www.ncbi.nlm.nih.gov/pubmed/9494004?tool=bestpractice.com[24]Han-Geurts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery. Br J Surg. 2007;94:555-561.http://www.ncbi.nlm.nih.gov/pubmed/17443854?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
早期术后喂食耐受性:有中等质量的证据表明早起术后喂食有相当好的耐受性。[21]Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial. Ann Surg. 1995;222:73-77.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=7618972http://www.ncbi.nlm.nih.gov/pubmed/7618972?tool=bestpractice.com[22]Feo CV, Romanini B, Sortini D, et al. Early oral feeding after colorectal resection: a randomized controlled study. ANZ J Surg. 2004;74:298-301.http://www.ncbi.nlm.nih.gov/pubmed/15144242?tool=bestpractice.com[23]Stewart BT, Woods RJ, Collopy BT, et al. Early feeding after elective open colorectal resections: a prospective randomized trial. Aust N Z J Surg. 1998;68:125-128.http://www.ncbi.nlm.nih.gov/pubmed/9494004?tool=bestpractice.com[24]Han-Geurts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery. Br J Surg. 2007;94:555-561.http://www.ncbi.nlm.nih.gov/pubmed/17443854?tool=bestpractice.com
术后肠梗阻持续时间:有中等质量证据表明硬膜外腔麻醉能减少术后肠梗阻的持续时间,但与阿片类镇痛药相比却不影响住院时间。[29]Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Dis Colon Rectum. 2001;44:1083-1089.http://www.ncbi.nlm.nih.gov/pubmed/11535845?tool=bestpractice.com[30]Gendall KA, Kennedy RR, Watson AJ, et al. The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis. 2007;9:584-598.http://www.ncbi.nlm.nih.gov/pubmed/17506795?tool=bestpractice.com[31]Senagore AJ, Delaney CP, Mekhail N, et al. Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg. 2003;90:1195-1199.http://www.ncbi.nlm.nih.gov/pubmed/14515286?tool=bestpractice.com[32]Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg. 2007;94:665-673.http://www.ncbi.nlm.nih.gov/pubmed/17514701?tool=bestpractice.com[28]Zingg U, Miskovic D, Hamel CT, et al. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: benefit with epidural analgesia. Surg Endosc. 2009;23:276-282.http://www.ncbi.nlm.nih.gov/pubmed/18363059?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
术后肠梗阻持续时间:有中等质量证据表明硬膜外腔麻醉能减少术后肠梗阻的持续时间,但与阿片类镇痛药相比却不影响住院时间。[29]Carli F, Trudel JL, Belliveau P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Dis Colon Rectum. 2001;44:1083-1089.http://www.ncbi.nlm.nih.gov/pubmed/11535845?tool=bestpractice.com[30]Gendall KA, Kennedy RR, Watson AJ, et al. The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis. 2007;9:584-598.http://www.ncbi.nlm.nih.gov/pubmed/17506795?tool=bestpractice.com[31]Senagore AJ, Delaney CP, Mekhail N, et al. Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg. 2003;90:1195-1199.http://www.ncbi.nlm.nih.gov/pubmed/14515286?tool=bestpractice.com[32]Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg. 2007;94:665-673.http://www.ncbi.nlm.nih.gov/pubmed/17514701?tool=bestpractice.com[28]Zingg U, Miskovic D, Hamel CT, et al. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: benefit with epidural analgesia. Surg Endosc. 2009;23:276-282.http://www.ncbi.nlm.nih.gov/pubmed/18363059?tool=bestpractice.com
手术后肠梗阻持续时间和安全数据:有中等质量证据表明术后患者嚼口香糖是安全的,可以有效缩短手术后肠梗阻的持续时间。[35]Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015;(2):CD006506.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006506.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25914904?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
手术后肠梗阻持续时间和安全数据:有中等质量证据表明术后患者嚼口香糖是安全的,可以有效缩短手术后肠梗阻的持续时间。[35]Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015;(2):CD006506.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006506.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25914904?tool=bestpractice.com
术后肠梗阻持续时间:有中等质量证据表明红霉素和甲氧氯普胺不会缩短肠梗阻的持续时间。[43]Traut U, Brügger L, Kunz R, et al. Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database Syst Rev. 2008;(1):CD004930.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004930.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/18254064?tool=bestpractice.com[64]Cheape JD, Wexner SD, James K, et al. Does metoclopramide reduce the length of ileus after colorectal surgery? A prospective randomized trial. Dis Colon Rectum. 1991;34:437-441.http://www.ncbi.nlm.nih.gov/pubmed/2036922?tool=bestpractice.com[65]Seta ML, Kale-Pradhan PB. Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Pharmacotherapy. 2001;21:1181-1186.http://www.ncbi.nlm.nih.gov/pubmed/11601663?tool=bestpractice.com[66]Smith AJ, Nissan A, Lanouette NM, et al. Prokinetic effect of erythromycin after colorectal surgery: randomized, placebo-controlled, double-blind study. Dis Colon Rectum. 2000;43:333-337.http://www.ncbi.nlm.nih.gov/pubmed/10733114?tool=bestpractice.com[67]Lightfoot AJ, Eno M, Kreder KJ, et al. Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. Urology. 2007;69:611-615.http://www.ncbi.nlm.nih.gov/pubmed/17445634?tool=bestpractice.com[36]Kraft MD. Emerging pharmacologic options for treating postoperative ileus. Am J Health-Syst Pharm. 2007;64:S13-S20.http://www.ncbi.nlm.nih.gov/pubmed/17909271?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
术后肠梗阻持续时间:有中等质量证据表明红霉素和甲氧氯普胺不会缩短肠梗阻的持续时间。[43]Traut U, Brügger L, Kunz R, et al. Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database Syst Rev. 2008;(1):CD004930.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004930.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/18254064?tool=bestpractice.com[64]Cheape JD, Wexner SD, James K, et al. Does metoclopramide reduce the length of ileus after colorectal surgery? A prospective randomized trial. Dis Colon Rectum. 1991;34:437-441.http://www.ncbi.nlm.nih.gov/pubmed/2036922?tool=bestpractice.com[65]Seta ML, Kale-Pradhan PB. Efficacy of metoclopramide in postoperative ileus after exploratory laparotomy. Pharmacotherapy. 2001;21:1181-1186.http://www.ncbi.nlm.nih.gov/pubmed/11601663?tool=bestpractice.com[66]Smith AJ, Nissan A, Lanouette NM, et al. Prokinetic effect of erythromycin after colorectal surgery: randomized, placebo-controlled, double-blind study. Dis Colon Rectum. 2000;43:333-337.http://www.ncbi.nlm.nih.gov/pubmed/10733114?tool=bestpractice.com[67]Lightfoot AJ, Eno M, Kreder KJ, et al. Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. Urology. 2007;69:611-615.http://www.ncbi.nlm.nih.gov/pubmed/17445634?tool=bestpractice.com[36]Kraft MD. Emerging pharmacologic options for treating postoperative ileus. Am J Health-Syst Pharm. 2007;64:S13-S20.http://www.ncbi.nlm.nih.gov/pubmed/17909271?tool=bestpractice.com