两种肠内置管途径在晚期上消化道恶性肿瘤患者家庭肠内营养的应用  

The application of two enteral nutrition ways in home enteral nutrition support in patients with advanced upper-gastrointestinal cancer

作　　者：孙大力[1] 李树民[1] 李为明[1] 岑云云[1] 陈雄志[1] 戚宇星[1] 许青文[1] 李奕俊[1] 孙岩波[1] 林岳瀛 杨婷[1] 徐鹏远[1] 

机构地区：[1]昆明医科大学第二附属医院胃肠外科二病区/云南省外科临床营养研究中心,昆明650101

出　　处：《重庆医学》2016年第35期4926-4928,4931,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81160114);云南省外科临床营养研究中心专项基金资助项目(2014NS089);云南省科技厅联合专项基金资助项目(2011FB196)

摘　　要：目的比较经皮内镜下胃/空肠造瘘术(PEG/PEJ)和鼻-空肠管(NT)置管在晚期上消化道恶性肿瘤患者家庭肠内营养(HEN)支持中的应用。方法选取2013年1月至2015年6月该院收治的111例接受HEN支持的晚期上消化道恶性肿瘤患者,根据肠内置管途径将其分为PEG/PEJ组(51例)和NT组(60例),比较两种置管方式在HEN中的应用情况、患者并发症发生率、病死率,并进行生存分析。结果 PEG/PEJ组肠内营养相关并发症和管道相关并发症发生率均低于NIT组,差异有统计学意义(P<0.05),而两组病死率比较差异无统计学意义(P>0.05)。出院后6个月累计生存率为43.9%。COX分析显示,肿瘤部位和置管方式是影响患者生存时间的独立因素(P<0.05)。结论 PEG/PEJ较NT置管可降低上消化道恶性肿瘤患者HEN支持的并发症发生率,延长患者生存时间。Objective To compare the application of percutaneous endoscopic gastrostomy/jejunostomy（PEG/PEJ） and naso-intestinal tube（NT） in home enteral nutrition（HEN） support in patients with advanced upper-gastrointestinal cancer. Methods A total of 111 cases of patients with advanced upper-gastrointestinal cancer in the Second Affiliated Hospital of Kunming Medical University from January 2013 to June 2015 were enrolled in this study. Among them,51 cases of patients receiving PEG/ PEj＂ were allocated to the PEG/PEJ group, while the other 60 cases of patients given NT were allocated to the NT group. The appli- cation status of two enteral nutrition ways in HEN support, the incidence of complications and the mortality were compared between the two groups,and the survival analysis was conducted, as well. Results The rates of enteral nutrition-related complication and pipeline-related complication in the PEG/PEJ group were significantly lower than those in the NT group,with statistically significant differences（P〈0.05）. There was no statistically significant difference in mortality between the two groups（P〉0.05）. The overall survival rate for 6 months was 43.9 %. The COX multivariate analysis illustrated enteral nutrition delivery ways and location of tumor were the major independent prognostic factors related to survival time（P〈0.05）. Conclusion The PEG/PEJ is an effec- tive way to carry out HEN support in patients with advanced upper gastrointestinal cancer, which might reduce the rate of complications and prolong the survival time.

关 键 词：肠道营养 经皮内镜下胃/空肠造瘘术 鼻-空肠管 生存分析 

分 类 号：R735[医药卫生—肿瘤]