腹腔镜肝癌切除术后早期肠内营养的临床应用价值  

Clinical application value of early enteral nutrition after laparoscopic hepatectomy for hepatocellular carcinoma

作　　者：姚金科[1] 陈捷[2] 商昌珍[2] 张晓[1] 黄延年[1] 陈亚进[2] 

机构地区：[1]中山大学孙逸仙纪念医院增城院区普通外科,广州511300 [2]中山大学孙逸仙纪念医院肝胆胰外科,广州510120

出　　处：《中华肝脏外科手术学电子杂志》2015年第3期165-168,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81372562);广东省科技计划项目(2012B031800378);高校基本科研业务费中山大学青年教师培育项目(14ykpy21)

摘　　要：目的探讨腹腔镜肝癌切除术后早期肠内营养的临床应用价值。方法本前瞻性研究对象为2013年11月至2014年6月在中山大学孙逸仙纪念医院行腹腔镜肝癌切除术的49例患者。采用随机数字表法将患者分为肠内营养组和静脉营养组。肠内营养组25例,男20例,女5例;平均年龄（49±17）岁。静脉营养组24例,男18例,女6例;年龄（51±14）岁。所有患者均签署知情同意书,符合医学伦理学规定。肠内营养组术后24 h开始给予安素营养液口服,维持至术后7 d。静脉营养组术后24 h内即开始给予静脉营养,维持至术后7 d。比较两组患者术后补充人血白蛋白总量、术后胃肠道功能恢复时间、术后住院时间和住院费用等。观察营养支持相关并发症发生情况。两组资料比较采用t检验或Wilcoxon秩和检验。结果肠内营养组术后静脉补充人血白蛋白总量为（40±11）g,明显少于静脉营养组的（45±10）g（t=-16.089,P〈0.05）。肠内营养组术后胃肠功能恢复时间为（25±8）h,明显短于静脉营养组的（43±11）h（t=-36.928,P〈0.05）。肠内营养组术后住院时间为（8±2）d,明显短于静脉营养组的（10±3）d（t=-12.025,P〈0.05）。肠内营养组的总住院费用为4.5（3.7~6.1）万元,明显少于静脉营养组的4.9（4.2~6.7）万元（Z=-18.495,P〈0.05）。肠内营养组发生腹胀、腹泻5例,静脉营养组发生腹胀、腹泻8例,调整剂量或输液速度后缓解。结论腹腔镜肝癌切除术后早期肠内营养有助于患者胃肠功能恢复,可有效减轻患者经济负担,总体疗效优于静脉营养。ObjectiveTo investigate the clinical application value of early enteral nutrition after laparoscopic hepatectomy for hepatocellular carcinoma （HCC）.MethodsA total of 49 patients with HCC undergoing laparoscopic hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between November 2013 and June 2014 were included in this prospective study. These patients were divided into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Twenty-five patients were divided into the enteral nutrition group, among them, 20 were males and 5 were females with the average age of （49±17） years old. Twenty-four patients were divided into the parenteral nutrition group, among them, 18 were males and 6 were females with the average age of （51±14） years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the enteral nutrition group were given Ensure nutrient solution orally 24 h after operation for 7 d and the patients in the parenteral nutrition group were given parenteral nutrition 24 h after operation for 7 d. The total human albumin supplemented volume, recover time of gastrointestinal function, length of hospital stay after operation and hospitalization expenses of the two groups were compared. The nutritional support associated complications were observed. The data of the two groups were compared usingt test or Wilcoxon rank-sum test.ResultsThe total human albumin supplemented volume after operation of the enteral nutrition group was （40±11） g, which was signiifcantly lower than （45±10） g of the parenteral nutrition group（t=-16.089,P〈0.05）. The recovery time of gastrointestinal function after operation of the enteral nutrition group was （25±8） h, which was signiifcantly shorter than （43±11） h of the parenteral nutrition group （t=-36.928,P〈0.05）. The length of hospital stay after hepatectomy of the enteral nutrition group was （8±2） d

关 键 词：癌 肝细胞 肝切除术 肠道营养 胃肠外营养 全 

分 类 号：R735.7[医药卫生—肿瘤]