肠内营养制剂在直肠癌术前肠道准备中的应用

目的:探讨直肠癌病人术前使用肠内营养(EN)制剂进行肠道准备的可行性和效果。方法:回顾分析378例行择期保肛手术的直肠癌病人,将其分为两组,研究组205例,术前均口服EN制剂(瑞能)进行肠道准备;对照组173例,术前均口服聚乙二醇进行机械性肠道准备(MBP)。观察两组病人术中肠道清洁度,比较术后30 d内吻合口瘘、感染并发症、非感染并发症和手术死亡的发生率,以及术后首次肛门排气时间、术后耐受固体食物时间和住院时间等。结果:两组病人术中肠道清洁度均较好,研究组病人术后总并发症率低于对照组(P<0.01),术后首次肛门排气时间和术后耐受固体食物时间均早于对照组(P<0.05和P<0.01)。两组病人的术后吻合口瘘、感染并发症、非感染并发症、手术死亡以及住院时间均无显著性差异(P>0.05)。结论:EN制剂用于直肠癌术前肠道准备可获得满意的肠道清洁度,减少术后并发症,加速胃肠功能恢复。

Application of enteral nutrition in preoperative bowel preparation for patients with rectal carcinoma

Objective: To investigate the feasibility and effect of enteral nutrition in preoperative bowel preparation for patients with rectal carcinoma.Methods: Clinical data of 378 patients with rectal cancer who received sphincter preserving surgery in the past five years in our department were retrospectively analyzed.The patients were divided into two groups.205 patients in the study group were applied with enteral nutrition(Supportan) as a kind of liquid diet in preoperative bowel preparation.173 patients in the control group were applied with oral polyethylene glycol as traditional mechanical bowel preparation.The colon cleanliness was observed intraoperatively in both groups,and the incidences of postoperative anastomotic leakage,infectious complications,non-infectious complications,operative mortality,the first passage of flatus,time to tolerate solid foods and hospital stay were compared.Results: The colon cleanliness were good in both groups.The postoperative complication rate of the study group was lower than that of the control group(P<0.01).The first passage of flatus and time to tolerate solid foods were earlier in the study group than the control one(P<0.05 and P<0.01).However,there were no significant difference in anastomotic leakage,infectious complications,non-infectious complications,operative mortality and hospital stay(P>0.05).Conclusion: Application of enteral nutrition in preoperative bowel preparation for patients with rectal carcinoma was safe and feasible.It could achieve satisfactory colon cleanliness.Compared with the traditional MBP,this method could reduce the postoperative complications of rectal cancer and enhance the recovery of the gastrointestinal function.