食管癌腔镜术后营养途径的选择

  目的  探讨食管癌腔镜术后不同营养途径对患者恢复的影响。  方法  回顾性分析2010年5月至2013年10月在郑州大学附属肿瘤医院胸外科行食管癌腔镜手术的310例患者临床资料, 其中术中放置鼻十二指肠管102例, 空肠造瘘98例, 术后早期进食110例。比较3组患者术前, 术后第4天血清白蛋白、体重; 术后第1次排气时间、住院时间; 吻合口瘘、肺部感染及鼻胃减压管拔除后咽喉不适、造瘘口渗液感染等导管相关并发症发生率。  结果  3组均无住院死亡。鼻十二指肠管组与空肠造瘘组术后第1次排气时间、住院时间相比无显著性差异, 而早期进食组较这两组时间明显缩短, 差异有统计学意义。3组患者均未出现术后急性胃扩张及胃排空障碍, 在吻合口瘘和肺部感染发生率方面差异无统计学意义。鼻十二指肠管组在鼻胃减压管拔除后咽喉部不适高于空肠造瘘组, 术后有11%的患者自行拔管。空肠造瘘组术后有5例患者出现造瘘口渗液, 其中有1例较严重者予拔除造瘘管, 有5例患者出现不全肠梗阻。  结论  早期经口进食是食管癌腔镜术后较适宜的营养途径, 符合患者的生理状态, 减少手术带来的应激, 提高患者的依从性, 促进加速康复, 缩短住院时间。 

Selection of nutrition routes for patients with esophageal cancer undergoing thoracolaparoscopic esophagectomy

  Objective  To compare three different routes for nutritional support after thoracolaparoscopic esophagectomy.  Methods  The clinical data of 310 esophageal cancer patients undergoing thoracolaparoscopic esophagectomy in Affiliated Cancer Hospital of Zhengzhou University from January 2010 to October 2013 were analyzed (early oral feeding group:110, nasojejunal tube feeding group:102, and jejunostomy tube feeding group:98).The serum albumin and body weights were compared among the three groups before operation and four days after operation.The postoperative recovery time of the first exhaust time and hospitalization days were also compared.The fistula of esophageal anastomosis, pulmonary infection, and complications from intubation such as throat inflammation were also compared.  Results  No postoperation mortality occurred in the three groups.In addition, no significant difference was observed between the nasojejunal tube group and jejunostomy group for the first exhaust time and hospitalization days.The recovery of the early oral feeding group was significantly faster than the other two groups.Postoperative acute dilatation of the stomach and functional delayed gastric emptying were not found in the three groups.The anastomotic leakage and pulmonary infection rate had no significant difference.The throat inflammation from intubation in the nasojejunal tube feeding group was significantly more than that in the jejunostomy tube feeding group.Eleven percent of the patients removed the tube by themselves.In the jejunostomy tube feeding group, five patients suffered from postoperative fistula drainage, including one case with serious symptoms.Five patients had incomplete ileus.  Conclusion  Early oral feeding is a suitable nutritional support route after thoracolapascopic esophagectomy and it is a good way to reduce operation stress, improve patient compliance, induce fast recovery, and shorten hospitalization days.