胰十二指肠切除术后经鼻肠营养管喂养和经空肠造瘘管喂养的疗效及相关并发症

Efficacy and related complications of nasojejunal tube feeding versus jejunostomy tube feeding on patients after pancreaticoduodenectomy

目的 探讨胰十二指肠切除(PD)术后经鼻肠营养管喂养(NJT)和经空肠造瘘管喂养(JT)的疗效及相关并发症的差异。方法 回顾性分析2014年1月至2017年12月在南京鼓楼医院行PD术的患者102例的临床资料,根据喂养方式不同分为NJT组和JT组,各51例。分析比较两组患者术后并发症发生率,导管相关并发症发生率及营养管效能指标。结果 两组患者胰腺质地、胰管直径、术中出血量和美国麻醉医师协会(ASA评分)、麻醉风险评分、并发症等级、二次手术发生率和胰瘘、感染性并发症、消化道出血、腹腔出血、高血糖、肠道相关并发症发生率差异无统计学意义(P>0.05)。NJT组出院后再次入院率、肠梗阻发生率、胃排空延迟发生率、营养管相关并发症发生率低于JT组,拔除鼻胃管的时间、完全经口进食的时间、拔除营养管时间术后住院时间均短于JT组,差异有统计学意义(P<0.05,P<0.01)。结论 PD术后NJT较JT更加安全,并发症较少。NJT可显著降低胃排空障碍的发生率,缩短术后住院时间。

Objective To investigate the efficacy and related complications of nasojejunal tube(NJT) feeding and jejunostomy tube(JT) feeding after pancreaticoduodenectomy(PD). Methods A retrospective analysis was performed on 102 patients who received PD at Nanjing Drum Tower Hospital from January 2014 to December 2017. According to different feeding methods, the patients were divided into NJT group(n=51) and JT group(n=51). The incidences of postoperative complications and catheter-related complications and the feeding tube efficiency indicators were compared between two groups. Results There was no significant difference in pancreatic texture, pancreatic duct diameter, intraoperative bleeding, American Society of Anesthesiologists(ASA) score, anesthesia risk evaluation score, grade of complication, incidences of secondary operation, pancreatic fistula, infectious complications, gastrointestinal bleeding, abdominal bleeding, hyperglycemia and intestinal related complications between two groups(P>0.05). The readmission rate, the incidences of intestinal obstruction, delayed gastric emptying and nutritional tube-related complications in NJT group were lower than those in JT group, and the time of removing nasogastric tube, the time of transition to oral feeding and the time of removing nutrition tube were shorter than those in JT group(P<0.05,P<0.01). Conclusion NJT feeding after PD is safer and has fewer complications compared with JT. It can significantly reduce the incidence of gastric emptying disorder and shorten the postoperative hospital stay.