空肠营养管植入对食管癌放疗的影响

Effect of jejunum tube implantation on radiotherapy for esophageal cancer

目的 了解空肠营养管植入对食管癌放疗患者减轻不良反应、改善结局及降低成本的影响.方法 以2014年8月至2016年12月北京市朝阳区桓兴肿瘤医院收治的有营养风险的82例食管癌患者为研究对象,其中行空肠营养管植入（植入组）与未行营养管植入（对照组）患者各41例,对其营养状况、临床疗效、不良反应及住院费用进行数据收集和比较.结果 放疗后植入组体质量指数（BMI）及血红蛋白均高于对照组[（21.7±0.5））kg/m^2比（19.5±0.3）kg/m^2;（120.0±2.1）g/L比（115.0±6.3）g/L],差异均有统计学意义（t=2.03,P=0.042;t=2.12,P=0.031）.放疗期间植入组不良反应发生率低于对照组[29.3 %（12/41）比51.2 %（21/41）],差异有统计学意义（χ^2=8.12,P=0.002）.植入组放疗有效率高于对照组[95.1 %（39/41）比87.8 %（36/41）],差异有统计学意义（χ^2=5.74,P=0.022）.植入组总医疗费用低于对照组（13.8万元比14.7万元,t=2.09,P=0.037）;植入组平均住院日短于对照组（42.1 d比48.4 d,t=2.27,P=0.029）.结论 对有营养风险的食管癌放疗患者给予空肠营养管植入式肠内营养支持,可减少不良反应的发生,提高疗效并缩短住院时间,节约医疗成本.

Objective To explore the effect of jejunum tube implantation on the reduction of adverse reactions,outcomes improvement and cost reduction in esophageal cancer patients with radiotherapy. Methods Eighty-two esophageal cancer patients with nutritional risk in Beijing Chaoyang District Huanxing Cancer Hospital from August 2014 to December 2016 were analyzed. Forty-one cases received jejunum tube implantation （implantation group） and 41 cases received non-nutrient tube implantation （control group）, and data on their nutritional status,clinical efficacy,adverse reactions,and hospitalization costs were collected and compared. Results Compared with the control group, the implantation group has higher body mass index [（21.7±0.5）kg/m^2vs. （19.5±0.3） kg/m^2,t =2.12,P =0.031], hemoglobin[（120.0±2.1） g/L vs. （115.0±6.3） g/L, t= 2.12, P= 0.031] and clinical efficacy [95.1 % （39/41） vs. 87.8 % （36/41）, χ^2= 6.11, P= 0.022]. The incidence of adverse reactions in implantation group was significantly lower than that in control group[29.3 % （12/41） vs. 51.2 %（21/41）,χ ^2=8.12,P=0.002）. The total cost in implantation group was lower than that in control group （138 000 yuan vs. 147 000 yuan, t= 2.09, P= 0.037）, and the average hospitalization day was significantly reduced （42.1 d vs. 48.4 d, t = 2.27, P = 0.029）. Conclusion Enteral nutrition support with jejunal feeding tube can reduce the incidence of adverse reactions, improve the curative effect, shorten hospitalization time and save medical cost for patients with esophageal cancer.