胰十二指肠切除术后患者早期肠内营养与肠外营养的比较

Early postoperative enteral nutrition vs parenteral nutrition in patients after pancreaticoduodenecto-my： a comparative study

目的探讨标准胰十二指肠切除术后不同的营养方式对于患者术后并发症的影响。方法对西安交通大学第一附属医院2009年1月至2013年1月接受标准胰十二指肠切除术的340例患者进行了回顾性对照研究。按照术后营养方式的不同分为术后早期肠内营养联合肠外营养组和单纯肠外营养组，对两组患者术前一般特征、病理结果、手术情况以及术后并发症等进行统计学分析。结果两组患者的术前基础状态、切除组织病理类型以及术中相关参数差异均无统计学意义。与全肠道外营养组相比，联合营养组胃排空延迟（DGE）发生率增加（15．9％比6．7％，P〈0．05），肺炎发生率增加（10．3％比3．6％，P〈0．05），鼻胃管放置时间[（5．6±0．2）d比（3．9±0．1）d，P〈0．05）]延长，住院费用亦增加[（65 397．0±861．2）元比（50 663．9±239．2）元，P〈0．05]。结论标准胰十二指肠切除术后早期肠内营养联合肠外营养可能导致DGE、肺炎的发生率及住院费用增加，并延长鼻胃管放置时间。因此，早期肠内营养的应用需严格谨慎。

Objective To evaluate the clinical efficacy of early enteral nutrition combined with additional parenteral nutrition （EEN ＋ PN） versus TPN （total parenteral nutrition） in patients after conven- tional pancreatieoduodenectomy （PD）. Methods From January 2009 to January 2013, 340 consecutive patients who underwent conventional PD with Child＇s reconstruction at the First Affiliated Hospital of Xi＇an Jiaotong University were enrolled into this single-center retrospective comparative study. There were 87 pa- tients in the EEN ＋ PN group and 253 patients in the TPN group. The preoperative baseline characteristics, histopathologieal types, intraoperative parameters and postoperative outcomes were recorded and compared between the two groups. Results There were no significant differences in the preoperative general charac- teristics data, pathological patterns, and intraoperative details. There were significantly higher rates in de- layed gastric emptying （ DGE ）, morbidity （ 15.9% vs 6. 7%, P 〈 0.05 ）, and pneumonia （ 10. 3% vs 3.6%, P 〈0. 05） ; significantly prolonged nasogastric tube removal time （5.6 ± 0. 2 days vs 3.9 ± 0. 1 days, P 〈 0. 05 ）, and increase in hospitalization expenses （65 397.0 ± 861.2 ） Yuan vs （50 663.9 ± 239. 2） Yuan, P 〈 0.05 ） in the EEN ＋ PN group when compared with the TPN group. Conclusions EEN ＋ PN after conventional PD was associated with increased rates of DGE and pneumonia, prolonged nasogas- tric tube removal time, longer EN duration and increase in hospitalization expenses. Hence, EEN should on- ly be performed prudently and selectively.