早期肠内营养对胃癌根治术患者术后恢复和免疫功能的影响

Effect of Early Enteral Nutrition on Postoperative Recovery and Immune Function in Patients Undergoing Radical Gastrectomy for Gastric Cancer

目的:评价早期肠内营养(EEN)对胃癌根治术患者术后恢复和免疫功能的影响。方法:选入2011年6月~2014年1月在我院行胃癌根治术治疗的患者60例,根据术后营养方式不同分为EEN组和全肠外营养支持(TPN)组,每组30例。比较两组患者机体恢复及免疫功能情况。术后随访3年,观察并记录两组无进展生存率和总生存率。结果:EEN组术后排气时间[(2.46±0.78)d vs(3.85±1.03)d]、排便时间[(4.03±1.17)d vs(5.67±1.23)d]、进流质时间[(5.88±1.30)d vs(7.26±1.59)d]、进半流食时间[(7.94±1.85)d vs(11.01±2.36)d]和住院天数[(14.87±2.56)d vs(17.54±3.30)d]均显著短于TPN组,差异均有统计学意义(P<0.05)。术后第1d,两组各项体液免疫指标(Ig A、Ig G、Ig M浓度)和细胞免疫指标(CD3+、CD4+和CD4+/CD8+水平)均显著下降(P<0.05),营养支持后逐渐恢复,而EEN组恢复幅度较TPN组大,差异具有统计学意义(P<0.05)。EEN组术后并发症总发生率显著低于TPN组(13.33%vs 36.67%,P<0.05)。EEN组患者1年、2年和3年无进展生存率和总生存率均稍高于TPN组,但差异无统计学意义(P>0.05)。结论:EEN可有效促进胃癌根治术患者的肠功能恢复,缩短住院时间,提高机体免疫功能,降低并发症的发生,值得在临床推荐应用。

Objective:To evaluate the effect of early enteral nutrition(EEN)on postoperative recovery and immune function in patients undergoing radical gastrectomy for gastric cancer.Methods:60 patients with gastric cancer underwent radical gastrectomy in our hospital from June 2011 to January 2014 were divided into EEN group and total parenteral nutrition(TPN)group according to the postoperative nutrition,30 cases in each group.The recovery and immune function of the two groups were compared.All patients were followed up for 3 years.The progression free survival rate and overall survival rate of the two groups were observed and recorded.Results:The postoperative exhaust time[(2.46±0.78)d vs.(3.85±1.03)d],defecation time[(4.03±1.17)d vs.(5.67±1.23)d],liquid diet time[(5.88±1.30)d vs.(7.26±1.59)d],semi liquid diet time[(7.94±1.85)d vs.(11.01±2.36)d]and length of stay[(14.87±2.56)d vs.(17.54±3.30)d]in EEN group were significantly shorter than those in TPN group,the differences were statistically significant(P<0.05).At postoperative 1 d,the humoral immune indices(Ig A,Ig G,Ig M)and cellular immunity indices(CD3+,CD4+and CD4+/CD8+)of two groups were significantly decreased(P<0.05),which gradually recovered after nutrition support,and the recovery of EEN group was larger than that of TPN group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in EEN group was significantly lower than that in TPN group(13.33%vs.36.67%,P<0.05).The 1 year,2 year and 3 year progression free survival rate and overall survival rate of patients in EEN group were higher than those in TPN group,but the differences were not statistically significant(P>0.05).Conclusion:EEN can effectively promote the recovery of intestinal function in patients undergoing radical gastrectomy for gastric cancer,shorten the length of stay,improve the immune function and reduce the incidence of complications,it is worthy of recommendation in clinical practice.