食管癌术中营养管的放置及围术期营养支持

王俊; 李芝; 甄福喜; 张憬; 骆金华

doi:10.3969/j.issn.1000-8179.20141722

食管癌术中营养管的放置及围术期营养支持

Feeding tube placement and postoperative nutritional support for esophageal carcinoma patients

摘要

摘要:
目的探讨食管癌患者术中营养管放置和围术期营养支持的实施方法与临床效果。
方法 2012年1月至2013年12月单手术组513例食管癌手术患者术中均常规放置营养管, 其中鼻肠管497例, 空肠造瘘16例。术后24 h后经鼻肠管给予肠内营养(enteral nutrition, EN)治疗, 并辅以肠外营养(parenteral nutrition, PN)治疗, 至全量EN后停PN支持。
结果所有患者均顺利放置营养管, 在观察期间无死亡、无营养代谢障碍。鼻肠管组吻合口瘘、肺部并发症及切口感染发生率与空肠造瘘组比较无显著性差异(P>0.05);空肠造瘘组肠梗阻发生率高于鼻肠管组患者(P < 0.05)。
结论食管癌患者术中有效放置鼻肠管及早期应用EN为食管癌术后安全有效的营养补给方法。

Abstract:
Objective This study aims to investigate the method and clinical outcomes of feeding tube placement and perioperative nutritional support for esophageal carcinoma patients.
Methods A total of 513 esophageal carcinoma patients who have undergone radical resection and reconstruction by a single operating group between January 2012 and December 2013 participated this study.Feeding tubes were inserted via the nasal path of 497 cases and by jejunostomy in 16 cases.Early enteral nutrition (EN) was administered through the feeding tubes 24 h postoperatively with a stepwise increase, whereas supplementation of parenteral nutrition (PN) was terminated until total EN.
Results Feeding tubes were successfully inserted in all patients during operation.No death or nutritional and metabolic disorders were documented during the observation period.No differences in anastomotic fistula, pulmonary complication, and incision infection were identified between the nasointestinal and jejunostomy groups (P>0.05).A higher incidence of intestinal obstruction was observed in the jejunostomy group than in the nasointestinal group (P < 0.05).
Conclusion Effective placement of nasointestinal tube and early enteral feeding are safe and effective methods for patients who have undergone esophagectomy for esophageal carcinoma.

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