A Prospective Randomized Controlled Trial of Efficacy of Gum Chewing on Gastrointestinal Recovery after Laparoscopic Colorectal Surgery

咀嚼口香糖對腹腔鏡結直腸癌切除術後腸道功能恢復之成效：前瞻性隨機控制試驗

辜漢章(Han-Chang Ku) ； 周家麟(Chia-Lin Cho) ； 王俞蓉(Yu-Rung Wang) ； 鄭立勤(Li-Chin Cheng) ； 岳芳如(Fang-Ju Yueh) ； 田宇峰(Yu-Feng Tian) ； 蔡宜蓁(Yi-Tseng Tsai) ； 廖惠娥(Whey-Er Liao)

《中華民國大腸直腸外科醫學會雜誌》 29卷1期 (2018/03) Pp. 1-7

https://doi.org/10.6312/SCRSTW.2018.29(1).10609

摘要

Purpose. Postoperative ileus has been considered a temporary disturbance in gastric and bowel motility following abdominal surgery. This study aimed to assess the effects of gum chewing after laparoscopic colorectal surgery. Methods. Patients were randomized into two groups: the experimental group (gum chewing), which chewed gum three times within 3 days after surgery (gum was chewed continuously for 15 min each time until the first passage of flatus), and the control group, which received usual care without using gum chewing. Results. After randomization, 30 patients (15 no gum; 15 gum) were included in our analysis. There was no significant difference in time to flatus (62.6 vs. 90.3 h, p = 0.07), postoperative pain scores (4.3 vs. 5.5, p = 0.201) and the length of operative hospital stay (11.8 vs. 14.4 days, p = 0.189) between patients assigned to the gum and no gum groups. However, time to remove the nasogastric tube (49.8 vs. 75.4 h, p = 0.015) were significant. Conclusion. Gum chewing changed the length of operative hospital stay after laparoscopic colorectal surgery. However, gum chewing following laparoscopy surgery did not demonstrate an effect on recovery of bowel function.

關鍵字

Gum chewing ； Colorectal surgery ； Flatus time ； Gastrointestinal function ； Ileus

並列摘要

目的：腹部手術後腸阻塞為常見的併發症，使得病人易出現腹脹、廣泛性腹痛、噁心、嘔吐、延遲的排便及排氣，因而延長了住院天數以及增加醫療費用的支出。本研究之目的在於以實證模式探討咀嚼口香糖對於腹腔鏡結直腸癌術後病人促進腸道功能恢復之成效。方法：本研究採實驗性研究設計，以抽籤方式將個案隨機分成實驗組(咀嚼口香糖)與對照組，實驗組於術後隔天開始咀嚼口香糖，一天三次，每次至少15分鐘，為期三天，如病人已出現排氣即可終止收案；對照組則維持一般常規，同樣監測三天。結果：在隨機分派後，共30位個案納入研究分析，其中實驗組及對照組各15人。兩組研究對象在排氣時間(62.6 vs. 90.3 h, p = 0.07)、術後疼痛指數(4.3 vs. 5.5, p = 0.201)及住院天數長短(11.8 vs. 14.4 days, p = 0.189)皆無顯著差異。然而術後移除鼻胃管時間有顯著差異(49.8 vs. 75.4 h, p = 0.015)。結論：本研究發現腹腔鏡結直腸癌術後咀嚼口香糖有助於減少住院天數。然而，咀嚼口香糖對於腹腔鏡術後腸道功能恢復並無明顯成效。

並列關鍵字

咀嚼口香糖 ； 結直腸癌 ； 排氣時間 ； 腸道功能 ； 腸阻塞

參考文獻

Purkayastha S, et al. Meta-analysis of randomized studies evaluating gum chewing to enhance postoperative recovery following colectomy. Arch Surg 2008; 143(8):788-93.

Chan MK, Law WL. Use of gum chewing in reducing postoperative ileus after elective colorectal resection: a systematic review. Dis Colon Rectum 2007;50(12):2149-57.

Schuster R, et al. Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg 2006;141(2):174-6.

Apostolopoulos P, et al. Clinical trial: effectiveness of chewing-gum in accelerating capsule endoscopy transit time--a prospective randomized, controlled pilot study. Aliment Pharmacol Ther 2008;28(4):405-11.

Asao T, et al. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002;195(1):30-2.