肠道金属支架联合肠内-肠外营养对结肠癌伴肠梗阻的应用效果分析

Analysis of the application effect of intestinal metal stent combined with enteral-parenteral nutrition on colon cancer complicated with intestinal obstruction

目的分析肠道金属支架联合肠内-肠外营养对结肠癌伴肠梗阻的应用效果。方法选取2019年3月至2022年3月首都医科大学附属北京友谊医院收治的86例结肠癌伴肠梗阻患者,以简单随机法分别纳入联合组和对照组,每组各43例。两组患者均接受肠道金属支架置入治疗,对照组患者接受肠外营养支持,联合组患者接受肠内-肠外联合营养支持。对比两组患者支架置入成功率、梗阻缓解率、支架置入相关并发症发生率、肠功能恢复时间、住院天数及费用,以及术前1 d和术后7 d营养指标、炎性指标变化。结果两组患者支架均成功置入,梗阻缓解率组间比较差异无统计学意义(P>0.05)。联合组患者支架置入相关并发症发生率、住院费用均显著低于对照组(均P<0.05),首次排气时间、首次排便时间均显著早于对照组(均P<0.05),住院天数显著短于对照组(P<0.05)。术后7 d,两组患者血白蛋白(albumin,Alb)、前白蛋白(prealbumin,PA)、血红蛋白(hemoglobin,Hb)水平均显著高于本组术前1 d(均P<0.05),肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)、白介素-10(interleukin,IL-10)和C反应蛋白(C-reactive protein,CRP)水平均显著低于本组术前1 d(均P<0.05)。术后7 d,联合组患者Alb、PA、Hb水平均显著高于对照组(均P<0.05),TNF-α、IL-6、IL-10、CRP水平均显著低于对照组(均P<0.05)。结论与肠外营养相比,肠内-肠外联合营养支持能够降低结肠癌伴肠梗阻患者肠道金属支架置入术后并发症发生率、促进胃肠功能恢复、缩短住院天数、降低住院费用,且对于患者营养状况、炎症状态的改善也有积极作用。

Objective To analyze the application effect of intestinal metal stent combined with enteral-parenteral nutrition on colon cancer comp licated with intestinal obstruction.Method Eighty-six patients with colon cancer comp licated with intestinal obstruction treated in Beijing Friendship Hospital,Capital Medical University from March 2019 to March 2022 were randomly divided into combination group and control group,with 43 cases in each group.Both groups received intestinal metal stent implantation,control group received parenteral nutrition support,and combination group received enteral-parenteral nutrition support.The success rate of stent implantation,the relief rate of obstruction,the incidence of complications related to stent implantation,the recovery time of intestinal function,the hospital day and expenses,as well as the changes of nutritional indexes and inflammatory indexes 1 day before operation and 7 days after operation were compared between the two groups.Result Stents were successfully implanted in both groups,and there was no significant difference in the relief rate of obstruction between the two groups(P>0.05).The incidence of complications related to stent placement and hospital expenses in combination group were significantly lower than those in control group(all P<0.05),the first exhaust time and the first defecation time were significantly earlier than those in control group(all P<0.05),the hospital day was significantly shorter than those in control group(P<0.05).Seven days after operation,the levels of albumin(Alb),prealbumin(PA)and hemoglobin(Hb)in both groups were significantly higher than those in the same group 1 day before operation(all P<0.05),the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)and C-reactive protein(CRP)were significantly lower than those in the same group 1 day before operation(all P<0.05).Seven days after operation,the levels of Alb,PA and Hb in combination group were significantly higher than those in control group(all P<0.05),and the levels of TNF-α,IL-6,IL-10 and CRP were significantly lower than those in control group(all P<0.05).Conclusion Compared with parenteral nutrition,enteral-parenteral nutrition support can reduce the incidence of postoperative complications,promote the recovery of gastrointestinal function,shorten the hospital day and reduce the hospitalization expenses of patients with colon cancer complicated with intestinal obstruction,and it also has a positive effect on improving the nutritional status and inflammatory status of patients.