联合营养支持对胰十二指肠切除术后病人肝功能和临床结局的影响

Impact of enteral nutrition combined with parenteral nutrition vs. single parenteral nutrition support onliver functions and clinical outcome of patients after whipple operations

目的比较胰十二指肠切除术后肠外营养（PN）联合肠内营养（EN）支持与单纯PN对病人术后肝功能与临床结局的影响。方法回顾我院2002年1月至2007年12月接受胰十二指肠切除术（duodenopancreatectomy，PD）共1（39例的临床资料，其中56例术后接受PN联合EN营养支持（PN＋EN组），53例单纯给予PN支持（PN组）；记录其一般资料，比较术后肝功能等指标变化，以及临床结局指标（死亡率、并发症、术后住院天数和住院费用等）。结果PD术后应用联合营养支持与单纯PN比较，PN＋EN组在术后14dALT、AST、TBIL、DBIL等指标的下降幅度显著高于PN组（P〈O．05）i肠道排气时间明显短于PN组，感染并发症发生率（8．9％）显著少于PN组（24．5％）；其他预后指标两组结果相似。结论胰十二指肠切除术后PN联合EN可改善病人肝功能、减少术后感染并发症。

Objective To observe the impact of enteral nutrition（EN） combined with parenteral nutrition（PN） support vs. single PN support on liver functions and clinical outcome of patients after Whipple operations. Methods The clinical data of 109 patients after Whipple operations were continually colleeted in Beijing Hospital from Jan. 2002 to Dec〈 2007. Fifty-six patients were fallen into EN plus PN group, and the rest 53 into single PN group. General conditions between two groups were comparable. Liver functions and post-operative complications were evaluated by routine methods and international con- sensus. Results The levels of ALT, AST, T-BIL and DBIL were significantly decreased in PN plus EN group as compared with those in single PN group on the postoperative day（POD）14 （P〈0. 05）. The average time of anal exsufflation in PN plus EN group was significantly shorter than in PN group. Infection rate in PN plus EN group（8.9 % ）was significantly lower than in PN group（24. 5 % ）. There was no significant difference in total complication rate, post-operative hospital stay and total cost between two groups. Conclusion For elder patients after Whipple Operations, EN plus PN can decrease post-op- erative infection rate, and improve Liver function.