早期肠内营养在腹腔镜胰腺手术中的临床价值  

Clinical value of early enteral nutritional support in pancreatic surgery patients

作　　者：李小艳[1] 陈国栋[2] 贺更生[2] 罗加兴[2] 

机构地区：[1]南华大学附属第一医院内分泌科,湖南衡阳421001 [2]南华大学附属第一医院肝胆胰外科,湖南衡阳421001

出　　处：《中国医学工程》2017年第5期34-37,共4页China Medical Engineering

基　　金：湖南省教育厅高校科技项目(15C1213);湖南省卫生计生委科研基金(B2017052)

摘　　要：目的探讨腹腔镜胰腺手术患者围手术期应用早期肠内营养支持的效果。方法分析12例腹腔镜胰腺手术患者入院时及术后1周营养及免疫指标的变化;记录术后肛门排气、排便时间及住院天数;观察消化道不良反应及统计并发症发生例数。结果各项营养及免疫指标术后1周较入院时均有所降低,其中血红蛋白及白蛋白降低更明显,比较差异有统计学意义(P<0.05)。术后首次下床及排便平均时间分别为(61.58±23)h和(97.42±22.35)h,术后平均住院天数为(16.42±9.02)d。围手术期消化道不良反应较低,腹腔镜胰体尾联合脾脏切除术1例发生B级胰瘘,2例腹腔镜胰十二指肠切除术出现C级胰瘘并引起腹腔出血。结论围手术期早期肠内营养支持为腹腔镜胰腺手术走向成熟奠定基础,可改善患者的预后。[Objective] To observe the effect of early enteral nutritional support on outcome of pancreatic surgery pattents. [Methods] The body weight （WT）, hemoglobin （HB）, albumin （ALB）. total protein （TP） and total lymphocyte count （TLC） were measured on the admission day and the 7th postoperation day respectively. The anal exhaust time and defecation time after surgery, the postoperative hospital stay, the gastrointestinal adverse reactions and complications after surgery were observed. [Results] The nutrition indicators of the 7th postoperation day were significantly lower than those of the admission, and the decline of HB and ALB was more significant （P 〈0.05）. The mean postoperative off-bed time was （61.58±23） hours, the time of defecation after surgery was （97.42±22.35） hours, and the hospital stay was （16.42±9.02） days. There was low incidence of gastrointestinal adverse reaction. One case treated with laparoscopic spleen-preserving distal pancreatectomy had pancreatic fistula above grade B, and two cases treated with laparoscopic pancreaticoduodenectomy had pancreatic fistula above grade C which lead to bleeding. [Conclusion] Perioperative early enteral nutrition support could improve the prognosis of pancreatic patients and lay the groundwork for the maturity of laparoscopic pancreatic surgery.

关 键 词：腹腔镜 胰腺疾病 肠内营养 

分 类 号：R459.3[医药卫生—治疗学]