术后早期肠内免疫营养在全腔镜食管癌根治术中的临床应用
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摘要
目的 :通过对全腔镜下食管癌根治术后病人早期应用肠内免疫营养(EIN),观察肠内免疫营养对病人术后营养状况、免疫功能和临床结局的影响。方法 :选取2015年5月~2016年10月在我院确诊为食管癌并行全腔镜食管癌根治术的病人90例,将入选病人按随机表分为肠内免疫营养组(EIN组)、普通肠内营养组(EN组)和肠外营养组(PN组),每组各30例。比较3组病人在术前1天和术后第1、3、7天的营养指标、免疫指标、C反应蛋白(CRP)及术后首次肛门排气时间、术后感染并发症例数、住院时间等。结果 :3组病人在年龄、性别、肿瘤位置、临床分期等方面差异均无统计学意义(P>0.05)。3组病人术前营养指标、免疫指标比较差异均无统计学意义(均P>0.05);术后第1天3组病人各指标较术前均明显减低(P<0.05);术后第3天3组病人各指标均呈上升趋势(均P<0.05),其中EIN组、EN组上升幅度比PN组快(P<0.05);术后第7天EIN组上升幅度最快(P<0.05)。3组病人术前CRP比较差异无统计学意义(P>0.05);术后第1天3组病人指标较术前明显上升(均P<0.05);术后第3天3组病人指标均呈下降趋势(P<0.05),其中EIN组、EN组下降幅度比PN组快(P<0.05);术后第7天EIN组下降幅度最快(P<0.05)。3组病人术后首次排气时间、术后肺炎并发症例数及住院时间相比差异具有统计学意义(P<0.05);3组病人在术后发生吻合瘘方面差异无统计学意义(χ2=1.071,P=0.585)。结论:全腔镜下食管癌根治术后早期应用肠内免疫营养能改善病人的营养状况、提高机体免疫应答能力、促进病人快速康复。
Objective: TTo evaluate the nutritional status, immune function and clinical effectiveness of early enteral immunonutrition in patients receiving totally endoscopic esophagectomy. Methods: There were 90 patients receiving totally endoscopic esophagectomy enrolled in Department of Thoracic Surgery of The Fourth Hospital of Hebei Medical University between May 2015 and October 2016.The patients were randomly divided into three groups, enteral immunonutrition group(EIN group, n = 30),common enteral nutrition group(EN group, n = 30)and parenteral nutrition group(PN group, n = 30). The levels of nutritional indexes, immune indexes, C-reactive protein(CRP) were measured preoperation and 1 day,3 days,7 days after surgery. We also observed the first postoperative anal exhaust time, infectious complications and the length of hospital stay. Results: There were no significant differences in age, gender, tumor location, clinical stage, CRP, the nutritional indexes and immune indexes between the three groups before operation.On the first day after operation, the nutritional indexes and immune indexes of the three groups were significantly lower than those before operation, then all the indexes began to recover. Otherwise, CRP of the three groups were significantly higher than those before operation, then fell down in the following days.,the rate of EIN group and EN group was faster than that of PN group on the day 3 after surgery and the EIN group was the fastest on the day 7 after surgery. There were significant differences in the first postoperative anal exhaust time, pneumonia and the length of hospital stay. And there was no significant difference in the incidence of anastomotic fistula between the three groups(χ2 = 1.071, P = 0.585). Conclusions: Postoperative early enteral immunonutrition can improve the nutritional status and the immune response, promote the rapid recovery in the patients receiving totally endoscopic esophagectomy.
Objective: TTo evaluate the nutritional status, immune function and clinical effectiveness of early enteral immunonutrition in patients receiving totally endoscopic esophagectomy. Methods: There were 90 patients receiving totally endoscopic esophagectomy enrolled in Department of Thoracic Surgery of The Fourth Hospital of Hebei Medical University between May 2015 and October 2016.The patients were randomly divided into three groups, enteral immunonutrition group(EIN group, n = 30),common enteral nutrition group(EN group, n = 30)and parenteral nutrition group(PN group, n = 30). The levels of nutritional indexes, immune indexes, C-reactive protein(CRP) were measured preoperation and 1 day,3 days,7 days after surgery. We also observed the first postoperative anal exhaust time, infectious complications and the length of hospital stay. Results: There were no significant differences in age, gender, tumor location, clinical stage, CRP, the nutritional indexes and immune indexes between the three groups before operation.On the first day after operation, the nutritional indexes and immune indexes of the three groups were significantly lower than those before operation, then all the indexes began to recover. Otherwise, CRP of the three groups were significantly higher than those before operation, then fell down in the following days.,the rate of EIN group and EN group was faster than that of PN group on the day 3 after surgery and the EIN group was the fastest on the day 7 after surgery. There were significant differences in the first postoperative anal exhaust time, pneumonia and the length of hospital stay. And there was no significant difference in the incidence of anastomotic fistula between the three groups(χ2 = 1.071, P = 0.585). Conclusions: Postoperative early enteral immunonutrition can improve the nutritional status and the immune response, promote the rapid recovery in the patients receiving totally endoscopic esophagectomy.
引文
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[2]Gao Y,Wang Y,Chen L,et a1.Comparison of open three-field and minimally invasive esophagectomy for esophageal cancer.Interact Cardiovasc Thorac Surg,2011,12(3):366-369.
[3]Takeuchi H,Kawakubo H,Kitagawa Y.Current status of minimally invasive esophagectomy for patients with esophageal cancer.Gen Thorac Cardiovase Surg,2013,61(9):513-521.
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[5]毛友生,赫捷,薛奇,等.全国食管癌规范化诊治推广之路.中华胃肠外科杂志,2013,16(9):801-804.
[6]Blom RL,Klinkenbijl JH,Hollmann MW,et a1.Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center.J Thorac Dis,2012,4(5):467-473.
[7]张裔良,马龙飞,马晓,等.常规吻合器行全腔镜Ivor-Lewis食管癌根治术的安全性和近期疗效.中华胸心血管外科杂志,2013,29(11):641-643.
[8]袁勇,胡杨,陈龙奇,等.分层吻合在胸腹腔镜食管癌切除术后的应用.中华胸心血管外科杂志,2016,32(8):470-473.
[9]韦海涛,李丽,王作培,等.全腔镜下食管癌根治Ivor-Lewis与Mc Keown术式近期临床疗效对比.中华胸心血管外科杂志,2016,32(8):495-498.
[10]施庆彤.胸腔镜手术与开胸手术治疗食管癌疗效比较.山东医药,2015,55(42):61-62.
[11]Osland E,Yunus R,Khan S,et a1.Early enteral nutrition with in24 h of intestinal surgery versus later commencement of feeding:a systematic review and meta analysis.J Gastrointest Surg,2009,13(6):1163-1165.
[12]方仕,麦海妍,卢味,等.肝部分切除术后早期肠内营养治疗的临床研究.肠外与肠内营养,2010,17(5):257-263.
[13]岳庆峰.食管癌病人手术后早期肠内营养研究进展.肠外与肠内营养,2016,23(2):120-123.
[14]杜志明,余冬敏,赖政洪,等.术后早期肠内营养对食管癌病人预后的影响.肠外与肠内营养,2016,23(2):87-90.
[15]Kazuhiko F,Kudsk KA.Nutrition and gut immunity.Surg Clin North Am,201l,9l(4):55-770.
[16]杨博,靳红义,王卫杰,等.肠内免疫营养对老年食管癌病人术后免疫水平的影响.肠外与肠内营养,2015,22(4):213-216.
[17]李卡,郭海燕,张静,等.术前使用免疫增强型肠内营养对结直肠癌病人术后营养和并发症影响的前瞻性研究.肠外与肠内营养,2014,21(6):329-332.
[18]周新华,蔡德珺,蒋晓松,等.肠内免疫营养制剂应用于食管癌术后病人的临床观察.肠外与肠内营养,2012,19(6):333-336.
[19]Hutton HD,Drummond HS,Fryer AA.The rise and fall of C-reactive protein:managing demand within clinical biochemistry.Ann Clin Biochem,2009,46(2):155-158.
[2]Gao Y,Wang Y,Chen L,et a1.Comparison of open three-field and minimally invasive esophagectomy for esophageal cancer.Interact Cardiovasc Thorac Surg,2011,12(3):366-369.
[3]Takeuchi H,Kawakubo H,Kitagawa Y.Current status of minimally invasive esophagectomy for patients with esophageal cancer.Gen Thorac Cardiovase Surg,2013,61(9):513-521.
[4]赫捷.中国抗癌协会食管癌专业委员会.食管癌规范化诊治指南.第2版.北京:中国协和医科大学出版社,2013:99-107,160-167.
[5]毛友生,赫捷,薛奇,等.全国食管癌规范化诊治推广之路.中华胃肠外科杂志,2013,16(9):801-804.
[6]Blom RL,Klinkenbijl JH,Hollmann MW,et a1.Results of the introduction of a minimally invasive esophagectomy program in a tertiary referral center.J Thorac Dis,2012,4(5):467-473.
[7]张裔良,马龙飞,马晓,等.常规吻合器行全腔镜Ivor-Lewis食管癌根治术的安全性和近期疗效.中华胸心血管外科杂志,2013,29(11):641-643.
[8]袁勇,胡杨,陈龙奇,等.分层吻合在胸腹腔镜食管癌切除术后的应用.中华胸心血管外科杂志,2016,32(8):470-473.
[9]韦海涛,李丽,王作培,等.全腔镜下食管癌根治Ivor-Lewis与Mc Keown术式近期临床疗效对比.中华胸心血管外科杂志,2016,32(8):495-498.
[10]施庆彤.胸腔镜手术与开胸手术治疗食管癌疗效比较.山东医药,2015,55(42):61-62.
[11]Osland E,Yunus R,Khan S,et a1.Early enteral nutrition with in24 h of intestinal surgery versus later commencement of feeding:a systematic review and meta analysis.J Gastrointest Surg,2009,13(6):1163-1165.
[12]方仕,麦海妍,卢味,等.肝部分切除术后早期肠内营养治疗的临床研究.肠外与肠内营养,2010,17(5):257-263.
[13]岳庆峰.食管癌病人手术后早期肠内营养研究进展.肠外与肠内营养,2016,23(2):120-123.
[14]杜志明,余冬敏,赖政洪,等.术后早期肠内营养对食管癌病人预后的影响.肠外与肠内营养,2016,23(2):87-90.
[15]Kazuhiko F,Kudsk KA.Nutrition and gut immunity.Surg Clin North Am,201l,9l(4):55-770.
[16]杨博,靳红义,王卫杰,等.肠内免疫营养对老年食管癌病人术后免疫水平的影响.肠外与肠内营养,2015,22(4):213-216.
[17]李卡,郭海燕,张静,等.术前使用免疫增强型肠内营养对结直肠癌病人术后营养和并发症影响的前瞻性研究.肠外与肠内营养,2014,21(6):329-332.
[18]周新华,蔡德珺,蒋晓松,等.肠内免疫营养制剂应用于食管癌术后病人的临床观察.肠外与肠内营养,2012,19(6):333-336.
[19]Hutton HD,Drummond HS,Fryer AA.The rise and fall of C-reactive protein:managing demand within clinical biochemistry.Ann Clin Biochem,2009,46(2):155-158.