中国普外基础与临床杂志

中国普外基础与临床杂志

胃癌术后早期肠内营养的临床应用

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目的 探讨胃癌患者术后早期施行肠内营养支持的临床价值。 方法 根据纳入和排除标准,本研究前瞻性纳入四川大学华西医院胃肠外科 2016 年 5 月 1 日至 2016 年 7 月 1 日期间收治的确诊为胃癌并行 Billroth Ⅱ 式+D2 胃癌根治术的患者 76 例,随机分为早期肠内营养支持组(简称营养支持组,36 例)和传统康复组(40 例)。传统康复组术后按照传统常规方法进行治疗,营养支持组从术后第 2 天予以肠内营养支持治疗。比较 2 组患者术后肠功能的恢复情况和术后不良反应情况以及 2 组患者术前与术后的实验室指标变化和体质量的变化情况。 结果 ① 2 组患者的一般资料比较差异均无统计学意义(P>0.05)。② 营养支持组患者术后首次肛门排气时间和首次肛门排便时间均明显短于传统康复组(P<0.05)。③ 传统康复组患者在治疗期间有 3 例出现腹胀、1 例出现腹泻,而营养支持组只有 1 例出现腹胀和 1 例出现呕吐,营养支持组的不良反应发生率明显低于传统康复组(5.6% 比 10.0%,P=0.035)。④ 2 组患者入院时的血清白蛋白、尿素氮、肌酐及淋巴细胞计数比较差异均无统计学意义(P>0.05);术后第 5 天时,营养支持组患者血清白蛋白水平明显高于传统康复组(P<0.05),其余指标 2 组间比较差异均无统计学意义(P>0.05)。⑤ 营养支持组和传统康复组患者术前的体质量比较差异无统计学意义(P>0.05);术后第 30 天时,营养支持组患者的体质量明显高于传统康复组(P<0.05)。 结论 本研究有限病例的初步结果提示,行 Billroth Ⅱ式+D2 胃癌根治术患者术后早期施行肠内营养支持是安全、有效的,有助于促进患者的胃肠功能恢复,有效改善其营养状况。

Objective To analyze clinical value of early enteral nutrition following radical resection of gastric cancer. Methods Seventy-six patients with gastric cancer underwent radical resection from May 1, 2016 to July 1, 2016 in the West China Hospital of Sichuan University were included according to the inclusion criteria and exclusion criteria, then were randomly divided into observation group (36 cases) and control group (40 cases). The patients in the observation group received the enteral nutrition on day 2 following the surgery, in the control group received the conventional management. The gastrointestinal recovery and the adverse reaction were compared in these two groups. The preoperative and postoperative laboratory indicators and the body weight of the patients in both groups were analyzed. Results ① The general data such as age, gender, and body weight had no significant differences in these two groups (P>0.05). ② The first anus exhaust time and the first defecation time of the observation group were significantly shorter than those of the control group (P<0.05). ③ The adverse reaction rate of the observation group was significantly lower than that of the control group (P<0.05). ④ On admission, the serum albumin, urea nitrogen, creatinine, and lymphocyte count had no significant differences in these two groups (P>0.05). On day 5 after the operation, the serum albumin of the observation group was significantly higher than that of the control group (P<0.05). ⑤ The body weight had no significant difference in these two groups before the operation (P>0.05), which in the observation group was significantly heavier than that of the control group on day 30 after the operation (P<0.05). Conclusion Preliminary results of limited cases in this study show that early enteral nutrition following radical resection of gastric cancer is safe and effective, it could promote gastrointestinal function resumption and effectively improve nutritional status.

关键词: 胃癌; 早期肠内营养; 根治性手术; 胃肠功能

Key words: gastric cancer; early enteral nutrition; radical resection; gastrointestinal function

引用本文: 梁涛, 呙宇兰, 伍晓汀. 胃癌术后早期肠内营养的临床应用. 中国普外基础与临床杂志, 2018, 25(2): 197-201. doi: 10.7507/1007-9424.201708057 复制

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