围手术期肠内营养对胃癌内镜黏膜下剥离术后患者免疫及营养状态的影响  

Effect of perioperative enteral nutrition on immune and nutritional status of patients with gastric cancer after endoscopic submucosal dissection

作　　者：朱书渊 沈海萍 Shu-Yuan Zhu;Hai-Ping Shen(Department of Gastroenterology,The Second People’s Hospital of Lishui,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市第二人民医院消化内科,浙江省丽水市323000

出　　处：《世界华人消化杂志》2025年第4期291-298,共8页World Chinese Journal of Digestology

基　　金：浙江省营养学会-宜昌人福青年营养(医)师科研专项基金,No.ZN-YCHP2023-011.

摘　　要：背景内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)利用高频电刀逐步剥离癌变组织,造成较大手术创伤,患者后续康复路径较长,肠内营养供给的方式、时机等需谨慎确定,目前关于围术期胃癌营养支持仍未形成规范化干预方案.目的探究围手术期肠内营养在拟行ESD术的早期胃癌患者中的应用效果及对患者术后免疫、营养状态的影响.方法选取2023-10/2024-10就诊于丽水市第二人民医院的100例拟行ESD术的早期胃癌患者为研究对象,依据随机数字表法分组,对照组、试验组各50例.对照组给予常规围术期营养指导,试验组基于对照组,给予围手术期肠内营养,均干预至患者出院.对比两组术后住院时间、胃肠功能恢复情况(首次排便、首次排气、恢复饮食时间)、前白蛋白(prealbumin,PA)、甘油三酯(triglyceride,TG)、白蛋白(albumin,ALB)、抑制性T细胞(T细胞CD8^(+))、营养风险筛查(nutritional risk screening,NRS)评分、总蛋白(total protein,TP)、辅助性T细胞(T细胞CD4^(+))及胃肠道不良反应.结果试验组术后住院、恢复饮食、首次排便及首次排气时间均较对照组短(P<0.05);出院时试验组T细胞CD8^(+)低于对照组,T细胞CD4^(+)高于对照组(P<0.05);术后1 d试验组TP高于对照组,ALB低于对照组(P<0.05),出院时试验组hemoglobin、ALB、TP、TG高于对照组(P<0.05),但两组术后1 d、出院时PA比较,无显著差异(P>0.05);两组术前、出院时NRS评分对比,无显著差异(P>0.05);试验组胃肠道不良反应总发生率(12.00%)较对照组(28.00%)低(P<0.05).结论围手术期肠内营养应用于拟行ESD术的早期胃癌患者中可有效改善患者胃肠功能,提升营养状态,降低胃肠道不良反应风险,有助于机体免疫功能的恢复.BACKGROUND Endoscopic submucosal dissection(ESD)uses high-frequency electrocution to gradually peel off cancerous tissue,causing major surgical trauma.Therefore,such patients’recovery path is long,and the method and timing of enteral nutritional supply need to be carefully determined.At present,no standardized intervention plan has been formed for perioperative nutritional support for gastric cancer patients.AIM To explore the effect of perioperative enteral nutrition on patients with early gastric cancer who are scheduled for ESD,as well as its impact on their postoperative immune and nutritional status.METHODS One hundred patients with early gastric cancer who were scheduled for ESD surgery at The Second People’s Hospital of Lishui from October 2023 to October 2024 were selected as the study subjects.They were divided into either a control group or an experimental group according to the random number table method,with 50 patients in each group.Both groups received routine perioperative nutrition,while the experimental group additionally received perioperative enteral nutrition.The interventions were continued until the patients were discharged.The postoperative hospitalization duration,gastrointestinal function recovery(times to first bowel movement,first gas exhaust,and resumption of diet),prealbumin(PA),triglyceride(TG),albumin(ALB),inhibitory T cells(CD8^(+)),nutritional risk screening(NRS)score,total protein(TP),helper T cells(CD4^(+)),and gastrointestinal adverse reactions were compared between the two groups.RESULTS The experimental group had shorter postoperative hospital stays,and times to recovery of diet,first bowel movement,and first gas exhaustion compared to the control group(P<0.05).At discharge,the experimental group had lower CD8^(+)T cells and higher CD4^(+)T cells than the control group(P<0.05).On postoperative day 1,the experimental group had higher TP and lower ALB levels than the control group(P<0.05).At discharge,the experimental group had higher hemoglobin,ALB,TP,and TG levels than th

关 键 词：胃癌 围术期 肠内营养 营养 免疫 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]