食管癌手术胸导管结扎对术后肠内营养支持的影响

Influence of Thoracic Duct Ligation on the Effectiveness of Enteral Nutrition after Esophagectomy

目的：了解胸导管结扎对载脂蛋白的影响和术后肠内营养支持的影响。方法：将31例食管癌手术患者分成胸导管结扎组（A组）和不结扎胸导管组（B组）。两组均在术中置入鼻十二指肠管,从术后第1天开始肠内营养直到术后第7天。所有病例均从术后第5天经口进食流质饮食。全部病例于术前1日、术日及术后第1、3、5、7日采取静脉血液,进行血清载脂蛋白电泳,检测α-脂蛋白,前β-脂蛋白,β-脂蛋白和乳糜微粒的含量,并将数据进行统计分析。结果：两组病例检测的所有指标均无统计学意义。其中A组1例术后发生乳糜胸,300m l/日-500m l/日,术后第5天以后胸腔引流量逐渐减少,第7天引流已经变得极少。同时术后第1天、第3天血中检测不到乳糜微粒。术后第5天血中查见乳糜微粒,第7天增加到正常水平。结论：胸导管结扎对患者载脂蛋白水平不产生影响,对肠内营养支持也不产生不良影响。大部分患者胸导管结扎后侧支循环的建立24小时即已达到完全程度,个别病例需要5天-7天时间。

Objective： To investigate the influence of thoracic duct ligation on the apolipoprotein and the effectiveness of enteral nutrition after esophagectomy.Methods： 31 patients with esophageal cancer received esophagectomy were divided into 2 groups based on whether their thoracic duct got ligated. 19 patients were in group A（ligated） and 12 in group B（unligated）.All patients were given enteral nutrition through nasointestinal tube placed in operation from the 1st day to the 7th day after operation.And all patients were given liquid diet on the 5th day.We sampled the patients＇ blood on the day before operation,the operation day and the 1st,3rd,5th,7th day after operation.We handled the blood serum with apolipoprotein electrophoresis to detect the amount of alpha-,beta-,prebeta-lipoprotein and chylomicra.The data was analyzed with SPSS.Results： There were considerable changes on all apolipoproteins,but no statistical difference was found between the two groups.Chylothorax occurred on 1 patient in group A.The amount of chest drainage was 300ml/day-500ml/day on initial 4 days.It decreased on the 5th day and vanished on the 7th day. Accordingly,chylomicra could not be detected on the 1st and 3rd day.It appeared on the 5th day and reached the preoperative level on 7th day.Conclusion： There is no influence of thoracic duct ligation on the apolipoprotein and the effectiveness of enteral nutrition.The establishment of lateral circulation can be accomplished within 24 hours in most patients,but a few patients need 5days-7days.