早期经口进食对远端胰腺切除术后胰瘘的影响

Effects of early oral feeding on pancreatic fistula after distal pancreatectomy

目的分析早期经口进食对远端胰腺切除术(distal pancreatectomy,DP)患者术后胰瘘的影响。方法选取2015年1月—2019年12月于徐州医科大学附属医院普通外科行DP患者,共189例,收集其临床资料进行回顾性分析。根据术后营养方式,将上述患者分为早期经口进食组(EOF组,n=77)和非早期经口进食组(NEOF组,n=112);发生胰瘘的患者共41例,早期经口进食者17例,非早期经口进食者24例。比较2组患者的胰瘘发生率。观察并记录2组胰瘘患者术后引流管留置时间、累积胰瘘闭合率、腹腔引流量、引流液淀粉酶水平以及术后并发症发生率。结果 2组患者的胰瘘发生率比较,差异无统计学意义(P>0.05)。2组胰瘘患者术后拔管时间,累积胰瘘闭合率,术后1、3、5、7d腹腔引流量,术后1-2、3-4、5-6、7-8d引流液淀粉酶水平,术后并发症发生率比较,差异无统计学意义(P>0.05)。与NEOF组比较,EOF组胰瘘患者住院时间更短,差异有统计学意义(P<0.05)。结论 DP术后早期经口进食不会增加胰瘘的发生率,也不会增加胰瘘的持续时间,且可减少胰瘘患者的术后住院时间。

Objective To analyze the effect of early oral feeding on pancreatic fistula after distal pancreatectomy(DP).Methods A total of 189 patients who underwent distal pancreatectomy in Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2019 were enrolled and their clinical data were retrospectively analyzed.According to postoperative nutrition methods,the patients were divided into two groups:an early oral feeding(EOF)group(n=77)and a non-early oral feeding(NEOF)group(n=112).There were 41 patients with postoperative pancreatic fistula,including 17 patients in the EOF group and 24 patients in the NEOF group.Both groups were compared for the incidence of pancreatic fistula.Their extubation time of abdominal drainage tube,cumulative pancreatic fistula closure rate,abdominal drainage volume,the level of amylase in drainage fluid,and the incidence of postoperative complications were recorded.Results There was no significant difference in the incidence of pancreatic fistula between the two groups(P>0.05).There were no significant differences in extubation time,cumulative pancreatic fistula closure rate,abdominal drainage volume 1,3,5 and 7 days after operation,the amylase levels in drainage fluid 1-2,3-4,5-6,and 7-8 days after operation and postoperative complications between patients with pancreatic fistula in the two groups(P>0.05).However,patients in the EOF group presented significantly shorter length of hospitalization stay than those in the NEOP group(P<0.05).Conclusions Early oral feeding after DP does not increase the incidence and duration of pancreatic fistula,and can shorten the length of hospitalization stay of patients with pancreatic fistula.