术中经皮穿刺空肠营养管或经鼻空肠营养管置入对食管癌患者围手术期营养支持的影响

Impact of transnasal feeding tube or percutaneous jejunal feeding tube on peri-operative nutrition support in esophageal carcinoma patients

目的比较经鼻空肠营养管及经皮穿刺空肠营养管对食管癌患者术后营养支持的影响。 方法我科2011年2月至2012年3月同组手术医师收治食管癌患者，根据病情接受经右胸及上腹正中两切口食管癌根治手术（Ivor-Lewis）或经左/右颈、右胸及上腹正中三切口食管癌根治手术。选择性使用经鼻空肠营养管（经鼻空肠营养组,n=48）及经皮穿刺空肠营养管（经皮空肠穿刺组，n=38）放置空肠营养管，术后早期给予肠内营养支持。 结果（1） 本研究86例食管癌患者，通过NRS 2002量表进行评估，营养风险发生率为25.58%，两组患者术前营养风险评估差异无统计学意义（P=0.806）；（2）经皮空肠穿刺组患者以三切口手术为主，手术时间较经鼻空肠营养组明显延长（P=0.000），两组术后全身炎症反应综合征时间（P=0.114）和术后住院时间（P=0.460）比较差异无统计学意义，表明两组患者手术创伤差异无统计学意义；（3）两组患者肠内营养开始给予时间相当（P=0.561），但经皮空肠穿刺组患者给予足量肠内营养时间较经鼻空肠营养组晚（P=0.032），可能与手术医师顾虑穿刺管腹腔瘘，导致肠内营养给予加量较为谨慎有关；（4）两组患者对营养管舒适度评价方面，经鼻空肠营养组患者自身耐受能力不同，评分为6.00（3.00）分，而经皮空肠穿刺组患者评分仅为1.00（3.00）分，经皮空肠穿刺组患者感觉营养管的舒适程度显著好于经鼻空肠营养组（P=0.000）。结论两种空肠营养管置入方式均安全可靠，术后营养支持效果良好；经皮穿刺空肠营养管置入患者感觉更为舒适，耐受力好，推荐使用。

ObjectiveTo compare the roles of transnasal （TN） feeding tube or percutaneous jejunal （PJ） feeding tube for peri-operative nutrition support in esophageal carcinoma patients. MethodFrom February 2011 to March 2012, patients with esophageal carcinoma underwent Ivor-Lewis or three-incision（right thoracotomy, middle laparotomy and left/right cervical incisions） by the same group of thoracic surgeons were selectively divided into two groups： TN group, supported with transnasal feeding tube （n=48）, and PJ group, supported with percutaneous jejunal feeding tube （n=38）. ResultsAccording to the evaluation by NRS 2002, the total nutritional risk rate among these esophageal carcinoma patients was 25.58%. No enteral feeding pathway-related complication was noticed. The starting time of enteral nutrition support, post-operative hospital stay, and duration of systemic inflammatory response syndrome showed no significant difference between these two groups. The starting time of enteral nutrition was similar in these two groups （P=0.561）; however, the time needed for full enteral nutrition was longer in the PJ group than in the TN group （P=0.032）. In addition, patients in the PJ group had significantly better scores on the degree of comfort than those in the TN group [1.00（3.00） vs 6.00（3.00）] （P=0.000）. ConclusionsBoth enteral feeding pathways are safe and suitable to postoperative enteral nutrition support. PJ nutritional tubes are recommended for esophageal carcinoma patients to feel more comfortable post-operatively