胃癌根治术后肠外营养与早期肠内营养的联合应用  

Combined postoperative parenteral nutrition and early enteral nutrition after radical resection for gastric cancer

作　　者：王骏扬[1] 林喆[1] 

机构地区：[1]吉林大学第二医院普外科,吉林130000

出　　处：《消化肿瘤杂志（电子版）》2013年第3期176-179,共4页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的比较胃癌术后肠外营养(PN)联合早期肠内营养(EN)与单纯肠内营养支持的效果,探讨其对于胃癌患者术后早期营养状态、免疫功能及并发症等方面的影响。方法我院2011~2013年间50例确诊为胃癌并行根治手术治疗的患者随机分为观察组和对照组,观察组27例患者术后接受肠外营养与早期肠内营养(EN+PN),对照组23例仅行单纯肠内营养(EN),检测患者术前、术后淋巴细胞总数、T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)和体重、血清白蛋白、前白蛋白等营养指标,并比较两组患者吻合口瘘、腹胀、腹泻等并发症发生率以及发热时间、住院时间。结果两组患者年龄、性别、术前BMI、胃切除方式、临床分期比较差异无统计学意义。与术前比较,观察组与对照组患者术后8天体重均有下降,白蛋白和前白蛋白水平均有升高;但观察组体重下降幅度显著低于对照组,营养指标升高幅度显著大于对照组。两组患者术后淋巴细胞总数、CD3+、CD4+、CD8+细胞、CD4+/CD8+比值均降低,术后3天开始回升,观察组术后7天升高幅度显著高于对照组。观察组术后吻合口瘘、腹胀、腹泻等并发症发生率以及发热时间、住院时间显著低于对照组。结论胃癌术后肠外营养与早期肠内营养联合应用较单纯肠内营养更具优越性,可降低术后并发症发生率,缩短住院时间,改善患者的营养水平及免疫功能。Objective To investigate the clinical outcomes of combined postoperative parenteral nutrition(PN) and early enteral nutrition(EN) after radical resection for gastric cancer,and compare the postoperative nutritional status,immunity,morbidity and hospital stay between the EN plus PN group and EN group. Methods From May 2011 to May 2013,50 gastric cancer patients undergoing radical resection were randomly divided into two groups. The combined group(n =27) received combined postoperative PN and early EN,and the control group only received postoperative EN. The postoperative nutritional status,immunity,morbidity and hospital stay were compared between the two groups. Results There were no differences in age,gender,preoperative BMI,total or distal gastrectomy,and clinical stage between the two groups. The patients' weight decreased,and albumin and prealbumin levels increased significantly on the 8th day after operation in both groups,but the patients' weight decreased less and the albumin and prealbumin levels increased more in the combined group than those in the control group(P <0.05). The lymphocyte count,CD3+,CD4+,CD8+cells,CD4+/ CD8+ratio decreased significantly after operation,rose again on the3 rd postoperative day,and increased more on the 7th postoperative day in the combined group than those in the control group(P <0.05). The complication rate was significantly lower,and the duration of fever and hospital stay were shorter in the combined group than those in the control group. Conclusions Parenteral nutrition plus early enteral nutrition after radical resection for gastric cancer has more advantages than enteral nutrition alone. The combined nutrition support can reduce the incidence of postoperative complications,shorten hospital stay,and improve the patients ' nutritional status and immunity function.

关 键 词：胃癌 围手术期 肠内营养 肠外营养 

分 类 号：R735.2[医药卫生—肿瘤]