改良穿刺式空肠造瘘术在食管癌切除术中的应用  

Application of Modified Puncture Jejunostomy in Resection of Esophageal Carcinoma

作　　者：张伟清[1] 黄金龙[1] 林栋梁[1] 许振东[1] ZHANG Weiqing;HUANG Jinlong;LIN Dongliang;XU Zhendong(Department of Thoracic Surgery,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院胸外科,福建泉州362000

出　　处：《中国卫生标准管理》2022年第24期90-95,共6页China Health Standard Management

摘　　要：目的探讨经横结肠系膜穿刺式空肠造瘘术应用于食管癌切除患者的安全性和有效性。方法选取2020年1月—2021年12月在福建医科大学附属泉州第一医院胸外科食管癌切除的患者146例,随机分为两组,每组73例。研究组在术中采用经横结肠系膜的改良穿刺式空肠造瘘术;对照组则采用传统方式行穿刺式空肠造瘘术。两组均在术后24 h内开始饲入糖盐水或生理盐水,术后第1天开始予肠内营养乳剂持续饲入并逐步增加到生理需要量,然后维持至经口进食。所有患者出院后定期随访至少半年以了解有无迟发性肠梗阻、腹腔感染等导管相关并发症。对比两组在置管时间、营养管相关并发症、围手术期营养指标变化、手术相关并发症发生率方面的差异。结果所有的病例均顺利完成空肠营养管置入术,未发生围手术期死亡病例。中位随访时间13.6个月。研究组平均置管时间短于对照组,差异有统计学意义[(19.6±5.5)min vs.(26.3±9.4)min,P<0.05]。两组自动脱管、堵管、腹腔感染、穿刺部位感染、渗血、渗漏发生率方面对比,差异无统计学意义(P>0.05)。两组围手术期营养指标对比,差异均无统计学差异意义(P>0.05)。研究组肠梗阻发生率低于对照组(1.36%vs.9.58%,P<0.05);而其他手术相关并发症包括吻合口瘘、肺部感染、乳糜胸、脓胸、伤口愈合不良或感染、术后30 d内死亡率相比,差异无统计学意义(P>0.05)。结论经横结肠系膜的改良穿刺式空肠造瘘术应用于食管癌手术患者中安全有效,相比传统的置管方式操作时间缩短,且能减少术后肠梗阻的发生率,值得进一步推广。Objective To explore the safety and effectiveness of puncture jejunostomy through transverse mesentery in patients with resection of esophageal cancer.Methods A total of 146 patients who underwent resection of esophageal cancer in the thoracic department of Quanzhou First Hospital Affiliated to Fujian Medical University from January 2020 to December 2021 were randomLy divided into two groups with 73 patients in each group.The study group underwent modified puncture jejunostomy through transverse mesentery during the operation.The control group received traditional puncture jejunostomy.Both groups were fed sugar saline or normal saline within 24 h after surgery,and enteral nutrition emulsion was continuously fed from the first day after surgery and gradually increased to the physiological requirement,and then maintained until oral feeding.All patients were followed up regularly for at least six months after discharge to check for delayed intestinal obstruction,abdominal infection and other catheter-related complications.The differences in catheterization time,nutritional tube related complications,perioperative nutritional indexes and the incidence of surgery-related complications were compared between the two groups.Results A total of 146 patients were included,including 73 in both the study group and the control group.All the cases successfully completed jejunal nutrition tube insertion,and no death occurred during perioperative period.The median follow-up time was 13.6 months.The mean catheterization time of the study group was shorter than that of the control group,and the difference was statistically significant[(19.6±5.5)min vs.(26.3±9.4)min,P<0.05].There were no significant differences in the incidence of automatic dislocation,tube blockage,abdominal infection,puncture site infection,bleeding and leakage between the two groups(P>0.05).There was no significant difference in perioperative nutritional indexes between the two groups(P>0.05).The incidence of intestinal obstruction in the study group was lower

关 键 词：空肠造瘘术 营养管 营养支持 肠梗阻 食管癌 食管切除 

分 类 号：R735[医药卫生—肿瘤]