早期肠内营养在机器人辅助全膀胱切除术围术期应用研究

Early enteral nutrition in the perioperative period of bladder cancer robot assisted total radical cystectomy

目的探讨机器人辅助全膀胱切除术围术期应用早期肠内营养的临床效果与安全性。方法选取行机器人辅助全膀胱切除术治疗肌层浸润性膀胱癌的患者32例,随机分为肠内营养组(EN组,15例)与肠外营养组(PN组,17例)。观察术后排气时间、总住院时间及并发症发生情况。结果 EN组术后排气时间为(51.8±21.3)h,短于PN组的(72.1±17.2)h;EN组总住院时间为(13.2±2.9)d,短于PN组的(17.9±4.1)d,差异均有统计学意义(P<0.05)。EN组手术并发症尿瘘、切口愈合不良的发生率分别为0、6.7%(1/15),低于PN组的23.5%(4/17)、29.4%(5/17),差异有统计学意义(P<0.05);EN组术后胃肠道相关并发症恶心呕吐、腹胀腹痛、腹泻的发生率分别为20.0%(3/15)、40.0%(6/15)、20.0%(3/15),高于PN组的11.8%(2/17)、23.5%(4/17)、5.9%(1/17),但差异无统计学意义(P>0.05);两组均无严重并发症(如严重肠梗阻、回肠吻合口瘘)发生,均不需二次手术。结论机器人辅助全膀胱切除术围术期应用早期肠内营养安全有效,不会增加并发症的发生率。

Objective To investigate the feasibility and safety of early enteral nutrition after total radical cystectomy. Methods A total of 32 patients with muscle invasive bladder cancer who underwent total radical eystectomy were randomly divided into the enteral nutrition group（ EN group, n = 15 ） and the parenteral nutrition group（ PN group, n = 17 ）. The exhaust time, the time of discharge and the complications were observed. Results The exhaust time in EN group was（51.8 ± 21.3 ）hours, which was shorter than that in the PN group（72. 1 ± 17. 2 ）hours;the discharge time in EN group was （13.2 ± 2. 9 ）days, which was shorter than that in PN group （17. 9 ±4. 1 ）hours ,and the difference between the two groups had statistical significance （P 〈 0.05 ）. The operative complications such as urinary fistula,undesirable healing rate was 0,6. 7% （1/15） ,which was lower than that in the PN group 23.5% （4/17）, 29.4% （5/17）（P 〈0. 05 ）;the gastrointestinal complications such as nausea and vomiting, abdominal distension and pain, diarrhea was 20. 0% （3/15） ,40.0% （ 6/15 ）, 20. 0% （ 3/15 ）, which was higher than those in PN group 11.8% （ 2/17 ）, 23.5% （4/17）, 5.9% （1/17） ,the difference has no statistical significance （P 〉 0.05 ） ;there were no serious complications （ such as acute intestinal obstruction,ileum anastomotic fistula） ,did not need secondary surgery. Conclusion It is feasible and safe to use enteral nutrition after total radical cystectomy without complications oceurence.