术后早期肠内免疫营养在全腔镜食管癌根治术中的临床应用

The clinical application of postoperative early enteral immunonutrition in totally endoscopic esophagectomy

目的 :通过对全腔镜下食管癌根治术后病人早期应用肠内免疫营养(EIN),观察肠内免疫营养对病人术后营养状况、免疫功能和临床结局的影响。方法 :选取2015年5月~2016年10月在我院确诊为食管癌并行全腔镜食管癌根治术的病人90例,将入选病人按随机表分为肠内免疫营养组(EIN组)、普通肠内营养组(EN组)和肠外营养组(PN组),每组各30例。比较3组病人在术前1天和术后第1、3、7天的营养指标、免疫指标、C反应蛋白(CRP)及术后首次肛门排气时间、术后感染并发症例数、住院时间等。结果 :3组病人在年龄、性别、肿瘤位置、临床分期等方面差异均无统计学意义(P>0.05)。3组病人术前营养指标、免疫指标比较差异均无统计学意义(均P>0.05);术后第1天3组病人各指标较术前均明显减低(P<0.05);术后第3天3组病人各指标均呈上升趋势(均P<0.05),其中EIN组、EN组上升幅度比PN组快(P<0.05);术后第7天EIN组上升幅度最快(P<0.05)。3组病人术前CRP比较差异无统计学意义(P>0.05);术后第1天3组病人指标较术前明显上升(均P<0.05);术后第3天3组病人指标均呈下降趋势(P<0.05),其中EIN组、EN组下降幅度比PN组快(P<0.05);术后第7天EIN组下降幅度最快(P<0.05)。3组病人术后首次排气时间、术后肺炎并发症例数及住院时间相比差异具有统计学意义(P<0.05);3组病人在术后发生吻合瘘方面差异无统计学意义(χ2=1.071,P=0.585)。结论:全腔镜下食管癌根治术后早期应用肠内免疫营养能改善病人的营养状况、提高机体免疫应答能力、促进病人快速康复。

Objective： TTo evaluate the nutritional status, immune function and clinical effectiveness of early enteral immunonutrition in patients receiving totally endoscopic esophagectomy. Methods： There were 90 patients receiving totally endoscopic esophagectomy enrolled in Department of Thoracic Surgery of The Fourth Hospital of Hebei Medical University between May 2015 and October 2016.The patients were randomly divided into three groups, enteral immunonutrition group （EIN group, n = 30）,comrnon enteral nutrition group（EN group, n = 30）and parenteral nutrition group （PN group, n = 30）. The levels of nutritional indexes, immune indexes, C-reactive protein （CRP） were measured preoperation and lday,3days,7days after surgery. We also observed the first postoperative anal exhaust time, infectious complications and the length of hospital stay. Results： There were no significant differences in age, gender, tumor location, clinical stage, CRP, the nutritional indexes and immune indexes between the three groups before operation .On the first day after operation, the nutritional indexes and immune indexes of the three groups were significantly lower than those before operation, then all the indexes began to recover. Otherwise, CRP of the three groups were significantly higher than those before operation, then fell down in the following days,the rate of EIN group and EN group was faster than that of PN group on the day 3 after surgery and the EIN group was the fastest on the day 7 after surgery. There were significant differences in the first postoperative anal exhaust time, pneumonia and the length of hospital stay. And there was no significant difference in the incidence of anastomotic fistula between the three groups（χ^2 = 1.071, P = 0.585）. Conclusions： Postoperative early enteral immunonutrition can improve the nutritional status and the immune response, promote the rapid recovery in the patients receiving totally endoscopic esophagectomy.