Ivor-Lewis术中逆行置入法与空肠造瘘法置入空肠营养管比较  

The inverted nasojejunal tube implantation and jejunostomy in Ivor-Lewis esophagectomy patients

作　　者：张治[1] 袁方良[1] 任斌辉[1] 余勇[1] 董高悦[1] 李莉[1] 许林[1] 

机构地区：[1]江苏省肿瘤医院/南京医科大学附属肿瘤医院,南京210009

出　　处：《肿瘤代谢与营养电子杂志》2017年第3期303-306,共4页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：江苏省六大高峰人才重大课题(N2012-ws-115);江苏省肿瘤医院院课题(ZM201304)

摘　　要：目的为了探索Ivor-Lewis食管癌根治术中置入空肠营养管的方法,本文对比手术中逆行置入法与空肠造瘘法置入空肠营养管的利弊与临床效果。方法我们选取2010年1月至2013年12月江苏省肿瘤医院胸外科Ivor-Lewis食管癌根治术患者,根据置入空肠营养管的方法不同,分为两组,其中空肠造瘘组210例及逆行置入营养管组58例,进行临床效果的观察与总结。结果所有患者均顺利放置营养管,在观察期间无死亡、无营养代谢障碍。逆行置入营养管组肛门排气恢复明显较快,有显著性差异(P<0.01);而排便恢复时间虽短于空肠造瘘组,但差异无统计学意义(P<0.05)。空肠造瘘组1例发生完全性肠梗阻。逆行置入营养管组有2例患者将鼻空肠管拔出,空肠造瘘组则无意外脱管事件。结论相较于空肠造瘘术,逆行置入法是一种无创的肠内营养管置入技术,适用于Ivor-Lewis食管癌手术患者,它更简单、方便、实用且易于掌握,是一种安全有效的营养治疗途径,值得在临床推广应用。Objective This study aims to comparaethe method and clinical outcomes of the inverted nasojejunal tube placement and jejunostomy on patients undergoing Ivor-Lewis esophagectomy. Methods A total of 268 esophageal carcinoma patients who have undergone Ivor-Lewis esophagectomy between January 2010 and December 2013 participated this study. Feeding tubes were inserted via the inverted nasojejunal tube placement of 58 cases and by jejunostomy in 210 cases. We compared the clinical outcomes of two methods. Results Feeding tubes were successfully inserted in all patients during operation. No death or nutritional and metabolic disorders were documented during the observation period. Inverted nasojejunal tube placement group compared with jejunostomy group, the anus exhause recovery more faster, two groups are significant（P〈0.01）; though the anus bowel movement recovery time shorter than the jejunostomy group, two groups are unsignificant（P〉0.05）. An intestinal obstruction was observed in the jejunostomy group. Unplanned extubation occurred in two patients in inverted nasojejunal tube placement group. Conclusions Compared with jejunostomy, the method of inverted nasojejunal tube placement was a non-invasive technique, it was more convenient and practical, and it was easier to master. It was a safe and effective route of nutritional support, and was worthy of clinical application.

关 键 词：Ivor-Lewis食管癌手术 肠内营养 空肠造瘘术 逆行置入法 

分 类 号：R735.1[医药卫生—肿瘤]