穿刺导管空肠造口术对食管癌患者术后肠内营养支持的临床意义

Clinical significance of fine-needle cathter jejunostomy on enteral nutrition support for esophageal carcinoma patients after operation

目的研究食管癌患者经过重大手术以后,如何通过肠内营养改善机体营养状态,安全接受辅助放、化疗。方法 2011年4月至2012年4月对40例(EN组)食管癌患者采取了针刺导管空肠造口(FKJ)模式的营养支持,并设立40例对照组。入组患者符合下述条件:(1)两组患者的基本情况和疾病病程有可比较性;(2)术中及术后无严重并发症;(3)EN组术后FKJ提供肠内营养≥2个月;(4)随访时间≥6个月。EN组术后带管出院,居家自行给以瑞代1000 ml/d,持续≥2个月。对照组术前及出院后均不提供肠内、外商品营养制剂。结果术后3个月EN组患者体重及血清总蛋白、白蛋白含量明显好于对照组(P<0.05),但6个月时各项指标有所接近。EN组NK细胞、IgM和IgG均较对照组有所升高,但没有统计学意义。EN组完成辅助治疗的患者比例为89.65%,对照组为75%。后续治疗中EN组肺炎3例,腹泻7例;对照组肺炎4例,腹泻2例。结论 FKJ管道可以有效地长期的提高患者机体的营养状态,对顺利接受术后的各种辅助治疗有重要的意义。

Objective To investigate the mechanism of improving nutrition status via enteral nutrition（EN） in esophageal carcinoma patients after radical surgery so that they can undergo chemotherapy and radiotherapy safety. Methods From April 2011to April 2012,80 patients with esophageal carcinoma were divided into two groups randomly, EN group 40 cases and control group 40 cases. Their physical condition and illness status were comparable and no serious perioperative complication. EN group patients received fine-needle cathter jejunostomy （FKJ） enteral nutrition support （Fresubin Diebetes 1000 ml per day） at least 2 months after surgery. There was no enteral or paraenteral support in control group before operation or out-patient. Results The content of serum total protein and albumin in EN group was higher than that in control group at 3 month after operation（P〈0.05）. The content was similar in two groups at 6 month after operation. The content of NK cell, IgM, IgG in EN group was a bit higher than that in control group, however, was not statistically significant. 89.65%patients of EN group and 75%patients of control group completed the adjuvant therapy successfully, but 3 cases of pneumonia and 7 cases of diarrhea occurred in EN group, 4 cases of pneumonia and 2 cases of diarrhea occurred in control group. Conclusion FKJ is a long-term effective treatment for improving the nutritional status of patient and helping them completing postoperative adjuvant therapy successfully.