胰十二指肠切除术后早期经口肠内营养安全性和可行性的临床研究

Dose early oral feeding decrease the risk of postoperative morbidity after pancreaticoduodenectomy?

目的:探讨胰十二指肠切除术后早期经口肠内营养的安全性和可行性。方法:回顾性调查研究57例行胰十二指肠切除术的病人,随机分为早期经口肠内营养组(EOF,n=28,术后2 d内开始经口进食)和延迟进食组(DOF,n=29,术后超过5 d经口进食)。比较两组病人术前和术后第1、7和14天血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)水平、淋巴细胞计数以及术后并发症和平均住院时间。结果:两组病人胰十二指肠切除术后PA水平明显下降(P<0.05)。两组病人术后并发症比较无显著性差异,但DOF组病人二次手术发生率较EOF组明显增多(P<0.05);同时DOF组病人住院时间也长于EOF组(P<0.05)。结论:胰十二指肠切除术后EOF不仅能改善病人的营养状况,不增加并发症的发生率,而且还可降低二次手术的发生率、缩短住院时间。

Objective： We set out to evaluate nutrition conditions and the incidence of complication,hospital stay and nutritional intake between early oral feeding（EOF） and delay oral feeding（DOF） in patients undergoing pancreatoduodenectomy（PD）.Methods： We retrospectively investigated 57 patients（37 men and 20 women;mean age 58.9 years;range,36-78 years） who had underonge PD between October 2003 and May 2009 at the Chonbuk National University Hospital.The patients were divided into 2 groups：those who started to have an early oral feeding（EOF group,n=28） within postoperative day（POD） 2 and delay oral feeding（DOF group,n=29） after POD 5.Results：Postoperation EOF prealbumin was significantly higher than DOF（P=0.026）.There were no significant difference in the patients characteristics and other postoperative complications between the two groups.But reoperation rate was significantly higher in DOF compared with EOF（27.6% verus 4.0%;P=0.026）.Mean postoperative length of stay was significantly longer in DOF than in EOF（respectively 35.5±17.9 days and 25.1±7.6 days,P=0.023）.Conclusion： Postoperative EOF dose not increase complications and is safe with a reduction of reoperation rate and hospital stay and improvement of nutritional intake for PD patients.