腹腔镜胃癌根治术后早期肠内营养的疗效及安全性分析
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摘要
目的:观察并比较术后早期行肠内营养支持与常规输液对腹腔镜胃癌根治患者的疗效及安全性。方法:58例腹腔镜胃癌根治患者随机分为两组,肠内营养组(29例)于术后24 h经空肠营养管行肠内营养。对照组(29例)行常规静脉输液。比较两组患者营养指标、免疫功能、临床指标以及术后并发症发生率的差异。结果:肠内营养组术后第7天患者ALB、PA、CD3~+T(%)、CD4~+T(%)、CD4/CD8比值高于对照组,差异有统计学意义(P<0. 05)。与对照组相比,肠内营养组术后首次排气时间短、留置引流管时间短、术后住院时间短、住院总费用少(P<0. 05),肠内营养组总体并发症发生率(13. 79%)与对照组(17. 24%)比较差异无统计学意义(χ~2=0. 000,P=1. 000)。两组均随访6个月,未发生远期并发症及复发。结论:腹腔镜胃癌根治术后早期应用肠内营养,可以更好地改善术后营养状况和免疫功能,促进术后胃肠功能恢复,缩短住院时间;且不增加术后并发症发生率。
Objective: To compare the efficacy and safety of early enteral nutrition( EEN) and conventional intravenous infusion in patients gastric cancer undergone laparoscopic radical gastrectomy.Methods: Fifty-eight patients of gastric cancer undergone laparoscopic radical gastrectomy were randomized into enteral nutrition group( n = 29) and the control group treated with conventional intravenous infusion( n = 29).Enteral nutrition support was started 24 hours after surgery.Then the two groups were compared regarding the nutritional indexes,immune capacity,clinical outcomes and postoperative complications.Results: Patients in the enteral nutrition group had higher levels of albumin( ALB),pealbumn( PA),CD3~+T,CD4~+T and CD4/CD8 than those of the control subjects by the 7~(th)day after surgery( P<0. 05).Early first exhaust,shortened maintenance of drainage tube and hospital stay as well as reduced total hospital cost were seen in patients received enteral nutrition( P<0. 05),however,the two groups remained insignificant in overall incidence of complications( 13. 79% vs. 17. 24%)( χ~2= 0. 000,P = 1. 000).Six-month follow-up showed no long-term complications and relapse in the two groups.Conclusion:Early enteral nutrition may be effective and safe in patients of gastric cancer following laparoscopic radical gastrectomy,and improve the nourishment state and immune function as well as contribute to earlier gut function recovery,shorten hospital stay and reduce postoperative complications.
Objective: To compare the efficacy and safety of early enteral nutrition( EEN) and conventional intravenous infusion in patients gastric cancer undergone laparoscopic radical gastrectomy.Methods: Fifty-eight patients of gastric cancer undergone laparoscopic radical gastrectomy were randomized into enteral nutrition group( n = 29) and the control group treated with conventional intravenous infusion( n = 29).Enteral nutrition support was started 24 hours after surgery.Then the two groups were compared regarding the nutritional indexes,immune capacity,clinical outcomes and postoperative complications.Results: Patients in the enteral nutrition group had higher levels of albumin( ALB),pealbumn( PA),CD3~+T,CD4~+T and CD4/CD8 than those of the control subjects by the 7~(th)day after surgery( P<0. 05).Early first exhaust,shortened maintenance of drainage tube and hospital stay as well as reduced total hospital cost were seen in patients received enteral nutrition( P<0. 05),however,the two groups remained insignificant in overall incidence of complications( 13. 79% vs. 17. 24%)( χ~2= 0. 000,P = 1. 000).Six-month follow-up showed no long-term complications and relapse in the two groups.Conclusion:Early enteral nutrition may be effective and safe in patients of gastric cancer following laparoscopic radical gastrectomy,and improve the nourishment state and immune function as well as contribute to earlier gut function recovery,shorten hospital stay and reduce postoperative complications.
引文
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[10] ARENDS J,BACHMANN P,BARACOS V,et al.ESPEN guidelines on nutrition in cancer patients.[J]. Clinical Nutrition,2017,36(1):11-48.
[2]李宁.胃肠外科围手术期新理念的整合与应用[J].中华胃肠外科杂志,2010,13(1):13-15.
[3]黄晓旭,许力,孙大勇,等.反穿刺技术在腹腔镜全胃根治术中的随机对照研究[J].中国微创外科杂志,2017,17(11):974-977.
[4]胡祥.2014年第4版日本《胃癌治疗指南》更新要旨[J].中国实用外科杂志,2015,35(1):16-19.
[5]黄晓旭,许力,朱家胜,等.早期肠内营养对胃癌患者术后并发症的影响[J].皖南医学院学报,2013,32(6):466-468.
[6]黎介寿.首选肠内营养的合理性[J].肠外与肠内营养,2013,20(6):321-323.
[7] FUJIYA K,TOKUNAGA M,MORI K,et al.Long-term survival in patients with postoperative intra-abdominal infectious complications after curative gastrectomy for gastric cancer:A propensity score matching analysis[J].Annals of Surgical Oncology,2016,23(5):1-8.
[8] BRAGA M. Perioperative immunonutrition and gut function.[J].Curr Opin Clin Nutr Metab Care,2012,15(5):485-488.
[9] SUN JK,MU XW,LI WQ,et al.Effects of early enteral nutrition on immune function of severe acute pancreatitis patients[J]. World Journal of Gastroenterology,2013,19(6):917-922.
[10] ARENDS J,BACHMANN P,BARACOS V,et al.ESPEN guidelines on nutrition in cancer patients.[J]. Clinical Nutrition,2017,36(1):11-48.