早期肠内免疫营养对食管癌根治术后近期生存质量及临床结局的影响  

Effects of early enteral immunonutrition on short-term quality of life and clinical outcome in patients with totally endoscopic esophagectomy

作　　者：徐延昭[1] 郭瑞霞[2] 张月峰[1] 温士旺[1] 吕会来[1] 朱永刚[1] 苏鹏[1] 田子强[1] XU Yanzhao;GUO Ruixia;ZHANG Yuefeng;WEN Shiwang;LV Huilai;ZHU Yonggang;SU Peng;TIAN Ziqiang(Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei 050011,China;Department of Radiation Oncology,the Fourth Hospital of Hebei Medical University,Shijiazhuang,Hebei 050011,China)

机构地区：[1]河北医科大学第四医院胸五科,石家庄050011 [2]河北医科大学第四医院放疗科,石家庄050011

出　　处：《重庆医学》2018年第11期1465-1469,1474,共6页Chongqing medicine

基　　金：河北省医学科学研究重点课题计划(20170148)

摘　　要：目的观察肠内免疫营养(EIN)对全腔镜食管癌根治术患者近期生存质量(QOL)及临床结局的影响。方法选取2015年5月至2016年11月在该院确诊食管鳞状细胞癌并行全腔镜食管癌根治术的患者110例,分为EIN组(n=56)和肠外营养组(PN组,n=54)。EIN组经空肠造口管给予肠内营养,PN组经中心静脉给予肠外营养。观察两组术前及术后生存质量、术后首次肛门排气时间、术后拔除引流管时间、术后并发症例数、住院时间等。结果 (1)术后EIN组全部功能项目得分均显著高于PN组(P<0.05),症状项目得分显著低于PN组(P<0.05)。(2)两组患者术后首次排气时间、术后拔除引流管时间、术后肺炎并发症例数及住院时间等相比较差异有统计学意义(P<0.05);两组患者吻合口瘘发生率差异无统计学意义(χ2=0.621,P=0.431)。(3)两组患者生存质量问卷评分(以总体健康状况为代表)与临床各指标(术后首次排气时间、拔管时间、住院时间)呈负相关(P=0.000),其中EIN组相关系数绝对值高于PN组。结论全腔镜食管癌根治术后早期应用EIN可提高患者的生存质量、改善患者的预后、促进患者的快速康复。Objective To analysis the short-term quality of life and clinical outcome of early enteral immunonutrition(EIN)used after operation in patients with totally endoscopic esophagectomy.Methods This randomized controlled trial enrolled 110 patients receiving totally endoscopic esophagectomy in department of thoracic surgery of the fourth hospital of Hebei medical university between May 2015 and November 2016.The patients were randomly divided into enteral immunonutrition group(EIN group,n=56)and parenteral nutrition group(PN group,n=54).The scale scores of quality of life,the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative infections and the length of hospitalization were compared between the two groups before operation and after operation.Results (1)There were no significant differences in age,gender,education,marital status,tumor location,clinical stage,intraoperative bleeding between the two groups(P>0.05).(2)There were no significant differences in the quality of life before operation(P>0.05);All functional scale scores of EIN group were significantly higher than PN group(P<0.05),while the symptom scale score were significantly lower than PN group(P<0.05).(3)There were significant differences in the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative pneumonia complications and the length of hospitalization in the two groups(P<0.05).There was no significant difference in the incidence of anastomotic fistula between the two groups(χ2=0.621,P=0.431 4)The scale scores of quality of life(the overall health status as the representative)had a negatively linear relationship with the clinical outcome(P=0.000),the absolute value of correlation coefficient in EIN group was higher than that in PN group.The higher score of the quality of life,the shorter time of the postoperative anal exhaust,removal of drainage tube and the length of hospitalization.Conclusion Enteral immunonutrition can improve the quality of li

关 键 词：食管肿瘤 胸腔镜 腹腔镜 食管癌根治术 肠内免疫营养 生存质量 临床结局 

分 类 号：R735.1[医药卫生—肿瘤]