腹腔镜结肠癌术后早期口服肠内营养的临床观察

Clinical observation of early oral enteral nutrition after laparoscopic colectomy

目的比较整蛋白肠内营养粉（TP）与含膳食纤维的肠内营养混悬液（TPF-FOS）用于腹腔镜结肠癌术后早期肠内营养的安全性和有效性。方法前瞻性人组拟行腹腔镜结肠癌手术的72例患者，按随机数字表法随机分人TP组或TPF—FOS组。从术后第1天开始给予口服肠内营养，并逐渐增加浓度和剂量。测定术前及术后第1和第7天血红蛋白、白蛋白、前白蛋白、白细胞总数、c反应蛋白和降钙素原，记录术后排气和排粪时间，以及发热、感染、腹泻、腹胀等发生情况。结果63例患者完成研究，其中TP组33例，TPF-FOS组30例；两组均无因为无法耐受口服肠内营养而退出研究者。与TP组相比，TPF-FOS组术后7d内排成形粪便的患者比例显著增高[76．7％（23／30）比27．3％（9／33），P〈0．01]；术后4～7d腹胀发生率显著降低{5．8％[7／（30×4）]比15．2％[20／（33×4）]，P〈0．05}。两组间术后营养指标、感染应激指标、术后排气时间和术后腹泻发生率方面的差异均无统计学意义（均P〉0．05）。结论TPF-FOS肠内营养混悬液和TP肠内营养粉均可安全用于结肠癌术后早期口服肠内营养；TPF-FOS可能更有助于术后胃肠动力的恢复。

Objective To investigate the effect and safety of two types of early enteral nutrition, total protein （TP） and total protein with fibers （TPF-FOS）, after laparoscopic colectomy. Methods Patients with colon cancer were divided into TP group and TPF-FOS group. Oral nutrition was given from the first postoperative day. Hemoglobin, albumin, prealbumin, white blood cell count, C-reactive protein, procalcitonin were tested before operation and on the first and seventh postoperative day. The time to first flatus, time to first bowel movement, fever, infection, and diarrhea were observed after operation. Results No significant difference was observed in hemoglobin, albumin, prealbumin, white blood cell count, C-reactive protein, and procalcitonin between these two groups. Higher proportion of patients defecated formed stool during the observation in TPF-FOS group （76.7% vs. 27.3%, P〈0.01 ）. Less abdominal bloating was found from the fourth to the seventh postoperative day in TPF-FOS group （5.8% vs. 15.2%, P〈0.05）. Conclusions Both TP and TPF-FOS can be safely used for early oral enteral nutrition after laparoscopic colectomy. TPF-FOS may be more beneficial to the recovery of gastrointestinal function.