克罗恩病外科营养支持临床分析

Clinical analysis on the surgical nutritional support of crohn's disease

目的探讨克罗恩病外科营养支持应用价值。方法回顾性分析1989～2009年4月因克罗恩病相关并发症进行外科处理的20例患者,对患者的营养状况、病变情况、手术方式及术后恢复情况、手术相关并发症进行统计分析。结果 20例患者近期体重下降10%以上,经营养支持后血红蛋白、血清白蛋白显著改善,体重有所增加,20例均能完成手术治疗,10例出院后继续肠内营养。20例手术,10例出现营养支持相关并发症,2例死亡(1例死于腹腔感染休克,1例死于腹部感染和肾衰竭);18例按期出院的患者情况良好,能口服营养素及进食维持体重。随访1年后,有3例病情复发,2例内科治疗包括肠内营养治疗好转,1例再次手术切除复发病灶。结论围术期营养不良是克罗恩病的常见并发症,术前术后积极进行营养支持对于改善患者的病情预后有重要意义。术后长期行肠内营养可能有缓解病情复发的作用。

Objective To discuss the practicing value on the surgical nutritional support of crohn＇ s disease. Methods 20 cases of crohn＇ s disease（ from 1989 to 2009,4） with related complications needed surgery, intervention were analyzed. The nutritional condition, disease condition, operative method, postoperative condition, and operation-related complications were analyzed statistically. Results The weight loss of all 20 cases 〉 10% , after nutritional support, their HB and albumin were improved, and weight were increased, and they all accepted operative therapy, 10 of them continued EN after out of hospital. After operation, 10 of them had related complications of nutritional support, and 2 cases died （ 1 case died from shock because of abdominal cavity infection ; another case died from abdominal infection and reual failure） ; The rest 18 cases were out of hospital as scheduled and in well condition, they could intake nutrients or take food orally to maintain body weight. After 1 year follow-up, 3 cases relapsed again, 2 cases improved ＇after EN therapy and 1 case conducted operation to cut lesion again. Conclusion Peri-operative malnutrition was the common complication of crohn＇ s disease, pre-operative and post-operative nutritional support had a important significance to the improvement of crohn＇ s disease. Post-operative EN therapy perhaps had effect on reliving the relapse of the crohn＇ s disease.