食管及食管胃交界癌术后早期序贯肠内营养支持的应用

目的探讨食管及食管胃交界癌术后早期序贯肠内营养支持的应用价值。方法将63例食管、食管胃交界癌患者随机分序贯肠内营养支持（SEN）组32例和全肠外营养（TPN）组31例。TPN组术后第1天经中心静脉输注葡萄糖、脂肪乳、氨基酸、维生素和电解质混合液，热卡30Cal／kg，持续应用8d。SEN组术后20～24h经空肠管滴注5％葡萄糖氯化钠500ml，次日应用维沃（1Cal／m1）＋肠外营养（PN），每日热卡同TPN，根据患者耐受情况，逐渐增加维沃用量，减少PN用量，待肠内营养达到目标热卡后PN停用，一般可于第4天达全量。观察术后并发症、肠内营养耐受情况、肛门排气时间。术前1d和术后第1、第8天分别测定血清白蛋白（ALB）、血清前白蛋白（PA），术前1d和术后第8天测量体重。结果所有患者均治愈出院。两组患者均无吻合口瘘发生，SEN组6例患者行肠内营养时出现腹泻（3～5次／d），经加大维沃稀释浓度和使用肠道收敛剂后好转。肛门排气时间SEN组（50±5）h，早于TPN组的（704-6）h，差异有统计学意义（P〈0．05）。两组术后第8天体重均较术前下降，但TPN组更明显（P〈0．05）。两组术后第1天ALB及PA均降低，第8天SEN组已接近术前水平，而TPN组仍然较低（P〈0．01）。结论早期序贯肠内营养支持有利于食管及食管胃交界癌患者术后胃肠功能的尽早恢复、营养状况的改善和体重的维持。

Objective To report the clinical application of early postoperative sequential enteral nutrition support for esophagus and gastroesophageal junction cancer. Methods 63 patients with esophageal and gastroesophageal junction cancer were randomly divided into sequential enteral nutrition （SEN） group of 32 patients and total parenteral nutrition （TPN） group of 31 patients. IN TPN group the 1st day of postoperation central venous infusion of glucose, fat emulsion, amino acids, vitamins and electrolyte liquid mixture with calorie 30Keal/kg/Day were given to postoperative 8 day. IN SEN group 20 - 24 hours after operation jejunal tube infusion of 5% glucose and sodium chloride 500mL was given and the next day application Vital （1Kcal/ml） ＋ parenteral nutrition （PN） were given. The daily caloric was same as TPN. Based on the patient＇s resistance by the situation, the amount of Vital was increased, PN reduced gradually. As target calories to be achieved from enteral nutrition, PN were disabled, which were normally the 4 days after surgery. Postoperative complications, tolerated enteral nutrition, the time of flatus were observed. 1 day before surgery, postoperative 1 and 8 days, respectively, serum albumin （ ALB）, prealbumin （PA） were testedo body Weight were assessed on 1 day preoperative and 8 day postoperative. Results All patients were clinically cured. Two groups of patients had no anastomotic leakage. In SEN group 6 patients bad diarrhea 3 - 5 times / day, Which were improved by increasing dilution of Vital and the use of intestinal astringent. IN SEN group, the time of flatus was 50 ± 5 hours, significantly earlier than the TPN group 70 ＋± 6 hours （ P 〈 0. 05 ）. 8 day after surgery compared with the preoperative body weight were down, but more obvious in TPN group （ P 〈 0. 05 ）. ALB and PA were lower on 1 st day after surgery in both groups, which in SEN group were close to the preoperative level on 8 day after surgery, while the TPN group is still lower （ P 〈 0. 01 ）. Conclusion Early sequential enteral nutrition is in favor of postoperative earlier resumption of gastrointestinal function in esophagus and gastroesophageal junction cancer, and improves nutritional status and weight maintenance.