Ⅱ、Ⅲ期食管癌术后早期肠内营养的临床应用分析

The clinical application and study of early enteral nutritionin postoperative patients with stage Ⅱ、Ⅲesophageal cancer

目的探讨食管癌术后早期肠内营养的可行性和临床应用价值。方法 220例Ⅱ、Ⅲ期食管癌患者术后分别给予肠外(PN)和早期肠内营养(EN)支持。分组对比患者术后恢复情况、营养支持费用、血液检测指标、并发症情况和出院后首次复诊的营养状况。结果 EN组较PN组患者肠鸣音恢复、肛门排气时间明显缩短,体重、人血白蛋白测量值术后第14 d和出院后首次复诊EN组明显高于PN组(P<0.05);EN组营养支持费用明显减少(P<0.05);术后第8 d、14 d外周血淋巴细胞计数EN组明显高于PN组(P<0.05);而2组术后吻合瘘、肺部感染、心律失常并发症发生率差异不明显。结论Ⅱ、Ⅲ期食管癌患者术后早期肠内营养安全可行,可以改善机体营养状况,促进患者的康复。对吻合口瘘等并发症的预防作用不明显,但可以明显缩短吻合瘘发生后的住院时间和降低治疗费用。

Objective To evaluate the feasibility and clinical value of early enteral nutrition in postoperative patients with esophageal cancer. Methods 220 patients with stage Ⅱ、Ⅲ esophageal cancer who received resection of esophageal cancer were divided into two groups randomly： parenteral nutrition group （PN） arid early enteral nutrition group （EN）. Complications, periph- eral blood and biochemical criteria, nutritional status, costs of nutrition and intestinal function re- covery time were compared between two groups. Results Compared with PN group, the time needed for recovery of bowel sounds and anal exhaustion of the EN group were significantly shorter, and the costs of nutrition was lower（P 〈 0.05）. The weight and seralbumin of the patients in EN group were significantly higher in day 14 after operation and in first return visit after discharge （P 〈 0.05）. The peripheral total lymphocytes were significantly higher in day 8 and 14 after operation （P 〈 0.05）. There was no statistical difference in the incidence of the complications of anastomotic fistula, pulmonary infection or arrhythmia between two groups. Conclusion Early postoperative enteral nutrition in patients with stage Ⅱ、Ⅲ esophageal cancer is safe and feasible. Enteral nutri- tion can improve the nutritional status and the recovery of the patients. It also can reduce the length of hospital stay and the costs of nutrition in patients with the complications of anastomotic fistula.