肠内营养在食管癌手术患者快速康复中的应用  

Enteral nutrition in enhanced recovery after surgery of the esophageal cancer

作　　者：刘军强[1] 李学昌[1] 文锋[1] 李军[1] 宋伟安[1] 尚立群[1] 岳彩迎[1] 龚太乾[1] LIU Jun-qiang LI Xue-chang WEN Feng LI Jun SONG Wei-an SHANG LI-qun YUE Cai-ying GONG Tai-qian(Department of the Thoracic Surgery Navy General Hospital of PLA, Beijing 100048, China)

机构地区：[1]海军总医院胸外科,北京100048

出　　处：《肿瘤代谢与营养电子杂志》2017年第2期212-215,共4页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：目的总结我院食管癌患者术后应用肠内营养对患者术后快速康复的意义。方法回顾性总结我科自2015年7月至2016年8月间进行肠内营养的60例食管癌手术患者,所有患者均在微创胸腹腔镜下行食管癌根治术,术中常规放置空肠造瘘管,术后第1天开始采用营养泵的方法经空肠造瘘管行肠内营养,营养量自30ml/h开始,逐渐增加至150ml/h。每日能量摄入量以25kcal/kg计算。术后患者排便后行食管碘油造影证实无吻合口瘘及胃排空功能正常后逐渐开始经口进食。根据进食量继续辅以经造瘘管行肠内营养。分别于术前及术后第1、3、7天测量血清白蛋白、前白蛋白及血常规情况。结果手术均为微创下食管癌根治术,胃代食管,行食管胃左侧颈部机械吻合。60例患者无围术期死亡,术后第3~4天肠道使用量可达到生理需要量,施行完全肠内营养。术后发生吻合口瘘8例,发生率13%,术后平均进食时间为术后第5.4天。术后平均住院天数9.8天,最大值20天,最小值7天。术后患者下床时间1.4天,术前和术后第1、3、7天血清前白蛋白分别为322±12mg/L、203±18mg/L、247±29mg/L、358±14mg/L。结论采用微创方法行食管癌根治术联合早期肠内营养可加快患者术后快速康复,缩短平均住院日。Objective To summarize the signifcance of enteral nutrition in patients with esophageal cancer after operation in our hospital. Methods A retrospective analysis of 60 cases of enteral nutrition in patients with esophageal cancer in our hospital from July 2015 to August 2016, all patients underwent the minimally invasive esophagectomy via VATS and laparoscope, and a jejunostomy was performed meanwhile. The frst postoperative day enteral nutrition implement using the method of nutrition pump by jejunal tube. The speed of nutrients from 30ml/h, gradually increased to 150ml/h. Daily energy intake are calculated with the 25kcal/kg. Postoperative defecation after esophageal lipiodol angiography confrmed anastomotic fstula and normal gastric emptying after beginning oral feeding. According to the quantity of food to assisted with enteral nutrition through the jejunal tube. Before operation and 1st, 3rd and 7th day after operation measurement of serum albumin, prealbumin and blood test. Results All patients were performed minimally invasive esophagectomy and a cervical esophagogastrostomy. No postoperative death happened, 3~4 days after operation with intestinal volume can achieve physiological requirements, the implementation of total enteral nutrition. Postoperative anastomotic fstula occurred in 8 cases, the incidence rate of 13%. The average postoperative oral time was 5.4 days after operation. The average postoperative hospital stay was 9.8 days, the maximum 20 days, minimum 7 days. Postoperative bed time was 1.4 days, the postoperative serum albumin were 322±12mg/L, 203±18mg/L, 247±29mg/L and 358±14mg/L respectly. Conclusions Minimally invasive surgery combined with early enteral nutrition in patients with esophageal cancer can accelerate the rapid recovery of patients after surgery, shorten the average length of hospital stay.

关 键 词：食管癌 微创手术 肠内营养 加速康复外科 

分 类 号：R459.3[医药卫生—治疗学]