空肠造瘘管与鼻肠管在胸腹腔镜联合食管癌手术患者肠内营养应用的效果比较

Application effects comparison of needle-catheter jejunostomy and nasojejunal tube feeding in patients with combined thoracoscopic and laparoscopic esophagectomy

目的 探讨经空肠造瘘管输入肠内营养与经鼻肠管输入肠内营养在胸腹腔镜联合食管癌切除术患者营养支持中的应用效果.方法 选取2015年5—12月安徽医科大学第一附属医院胸外科收治的50例行胸腹腔镜联合食管癌切除术的患者为研究对象,根据肠内营养方式不同分为观察组和对照组,每组25例.观察组患者在术中采用穿刺式空肠造瘘术完成空肠管置入,术后经空肠造瘘进行肠内营养支持;对照组患者经鼻置入鼻肠管行肠内营养支持.比较两组患者的带管舒适度、带管期间营养状况及术后恢复情况.结果 观察组患者置管后主观耐受程度、鼻咽部不适和恶心呕吐发生情况优于对照组（Z值分别为2.673、5.041、3.271;P〈0.05）;观察组患者术后7 d血清白蛋白值高于对照组,差异有统计学意义（t=3.841,P〈0.001）;观察组患者住院时间短于对照组、术后排气时间早于对照组、带管营养时间长于对照组,差异均有统计学意义（t值分别为-6.171、-4.246、5.128;P〈0.001）;两组患者营养管相关并发症发生率、术后白细胞数目及总蛋白水平差异无统计学意义（P〉0.05）.结论 胸腹腔镜联合食管癌切除术患者术后营养支持应用经空肠造瘘管与经鼻肠管进行肠内营养,均安全有效,但空肠造瘘管较鼻肠管具有更好的临床应用效果.

Objective To compare the clinical application effects of needle-catheter jejunostomy and nasojejunal tube feeding in the combined thoracoscopic and laparoscopic esophagectomy.Methods The study enrolled 50 patients from Department of Thoracic Surgery, the First Affiliated Hospital of Anhui Medical University, who received the combined thoracoscopic and laparoscopic esophagectomy from May to December 2015. According to the different nutritional approaches, patients under-covered the needle-catheter jejunostomy were assigned into observation group （n=25）, and patients under-covered the nasojejunal tube feeding were assigned into control group （n=25）, then by the different nutrition pathway patients were given the same nutritional approaches. The cannulation how easily or comfortably, nutritional condition and incidence of postoperative recovery were compared between two groups.Results The nutrient tube withdrawal rate, nasopharyngeal discomfort rate and nausea and vomiting rate in observation group were significantly less than that in control group （Z=2.673, 5.041, 3.271;P〈0.05）; the value of serum protein was higher in the observation group compared with that of control group 7 days after operation （t=3.841,P〈0.001）; the time of enteral nutritional, length of hospital stay and the exsufflation time of anus in observation group all were better than the control group （t=-6.171, -4.246, 5.128;P〈0.001）. There is no significantly difference of the morbidity related to nutrient tube, the number of white cells and the total protein level between two groups （P〉0.05）.Conclusions The needle-catheter jejunostomy and nasojejunal feeding are both safe work and effective, but the needle-catheter jejunostomy feeding is better.