直肠癌预防性回肠造口还纳术后早期肠内营养对肠功能康复的影响研究

Effects of early postoperative enteral nutrition on the recovery of intestinal function in rectal cancer patients after ileostomy retraction surgery

目的:探讨早期肠内营养(EEN)治疗对行造口还纳术的直肠癌预防性回肠造口病人术后康复过程的影响。方法:收集2018年1月至2021年12月在蚌埠医学院第一附属医院胃肠外科行造口还纳术的直肠癌根治术后的病人资料,依据术后是否行EEN治疗分为观察组(EEN)和对照组(非EN)。观察组术后12~24 h开始给予EN治疗[20~30 kcal/(kg·d)]。比较两组术后腹泻、胃肠功能恢复、粪便钙卫蛋白和肠屏障功能等指标。结果:所纳入的观察组(n=46)和对照组(n=44)一般资料未见显著差异(P>0.05),两组术后均出现不同程度的腹泻,但观察组术后5 d(χ^(2)=25.760,P<0.01)和10 d(χ^(2)=14.870,P<0.01)仍存在腹泻的比例,以及需要使用止泻剂(χ^(2)=10.180,P=0.001)的比例均低于对照组。同时,观察组恢复正常饮食时间(t=5.701;P<0.01)和术后住院日(t=7.343,P<0.01)短于对照组。术后5 d,两组外周血炎症指标未见显著差异(P>0.05),观察组病人粪便钙卫蛋白(t=11.690,P<0.01)、血清D-乳酸(D-Lactate;t=6.160,P<0.01)和肠脂肪酸结合蛋白(IFABP;t=6.583,P<0.01)水平低于对照组,且病人粪便钙卫蛋白水平与D-Lactate(r=0.833,P<0.01)和IFABP(r=0.842,P<0.01)均呈正相关关系。结论:术后早期EN可有效改善回肠造口还纳术后腹泻症状、结肠炎症和肠屏障功能,加速术后康复进程。

Objective:To clarify the effects of early postoperative enteral nutrition(EN)on the recovery of gastrointestinal function after ileostomy retraction for rectal cancer.Methods:Patients with rectal cancer undergoing ileostomy retraction during January 2018 to December 2021 at the First Affiliated Hospital of Bengbu Medical College were collected and divided into observation group(EN group)and control group(non-EN group)according to whether early EN treatment was performed after surgery.The indexes of observation group were given EN treatment[20~30kcal/(kg·day)]12~24 h after surgery.The postoperative diarrhea,gastrointestinal function recovery,fecal calprotectin,and intestinal barrier function were compared between the two groups.Results:Although,there was no significant difference in demographic data(P>0.05)between the observation group(n=46)and the control group(n=44),various degrees of diarrhea occurred in both groups after operation.The observation group had lower rates of diarrhea at 5 days(χ^(2)=25.760,P<0.01)and 10 days after operation(χ^(2)=14.870,P<0.01),as well as antidiarrheal agents needed(χ^(2)=10.180,P=0.001)when compared to the control group.At the same time,the days returned to normal diet(t=5.701,P<0.01)and length of postoperative hospital stay(t=7.343,P<0.01)in the observation group were significantly shorter than those of the control group.At the fifth day after operation,there was no significant difference in the levels of peripheral inflammation index between the two groups(P>0.05),but the levels of fecal calprotectin(t=11.690,P<0.01),serum D-lactic acid(t=6.160,P<0.01)and intestinal fatty acid-binding protein(t=6.583,P<0.01)in the observation group were lower than those of controls.Meanwhile,there was a significant positive correlation between fecal calprotectin and blood D-lactic acid(r=0.833,P<0.01)and IFABP(r=0.842,P<0.01)for patients enrolled in the present study.Conclusion:Early postoperative EN could effectively improve postoperative diarrhea,colitis,and intestinal barrier function after ileostomy retraction for patients with rectal cancer,while accelerating the process of postoperative rehabilitation.