早期肠内免疫营养在全腔镜食管癌根治术后老年病人中的应用

doi:10.3969/j.issn.1005-6483.2019.09.016

摘要/Abstract

摘要： 目的:通过对全腔镜食管癌根治术后的老年病人早期给予肠内免疫营养（EIN），观察EIN对术后营养、免疫状况及临床结局的影响。方法:2015年5月～2017年6月在我院确诊食管鳞状细胞癌并行全腔镜食管癌根治术病人96例，将病人按随机表分为肠内免疫营养组（EIN组，47例）和普通肠内营养组（EN组，49例）。两组均经空肠造口管给予EN。观察两组术前1天和术后第1、3、7天的营养、免疫指标及术后首次肛门排气时间、术后肺炎发生率、住院时间等。结果:术后第1天两组病人各指标较术前均明显减低（P<0.05）；术后第3天两组病人各指标均呈上升趋势（均P<0.05）；术后第7天两组病人各指标继续呈上升趋势（均P<0.05），其中EIN组上升幅度较快（P<0.05）。两组病人术后首次肛门排气时间比较差异无统计学意义（P>0.05），术后肺炎并发症例数及住院时间比较，差异有统计学意义（P<0.05）。结论: 全腔镜食管癌根治术后的老年病人，早期应用EIN可改善营养及免疫状态，促进快速康复。

关键词: 肠内免疫营养, 胸腔镜, 腹腔镜, 食管癌

Abstract: Objective:To evaluate the nutritional status，immune function and clinical effectiveness of early enteral immunonutrition in elderly patients receiving totally endoscopic esophagectomy.Methods:This randomized controlled trial enrolled 96 patients receiving totally endoscopic esophagectomy in Department of Thoracic Surgery of The Fourth Hospital of Hebei Medical University between May 2015 and June 2017.The patients were randomly divided into enteral immunonutrition group（EIN group，n=47）and common enteral nutrition group（EN group，n=49）.Both groups received enteral nutrition through jejunostomy tube.Before operation and 1，3，7day after operation，the levels of nutritional indexes and immune indexes were compared，the time of first postoperative anal exhaust，the number of postoperative infections and the length of hospitalization were also compared between the two groups.Results:On the first day after operation，the nutritional indexes and immune indexes of the two groups were significantly lower than those before operation（all P<0.05）；On the 3th day after operation，the indexes of the two groups were increased（all P<0.05）；On the 7th day after operation，the rate of EIN group was faster than that of EN group（P<0.05）.There were no significant differences in the time of first postoperative anal exhaust and the length of hospitalization（P>0.05）.The number of postoperative pneumonia complications and the length of hospital stay were statistically significant（P<0.05）.Conclusion:Enteral immunonutrition can improve the nutritional status and the immune response，promote the rapid recovery in elderly patients receiving totally endoscopic esophagectomy.

Key words: enteral immunonutrition, thoracoscopy, laparoscopy, esophageal cancer

徐延昭, 张缜, 郭强等. 早期肠内免疫营养在全腔镜食管癌根治术后老年病人中的应用[J]. 临床外科杂志, 2019, 27(9): 773-776.

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