Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery

Objectives: We have previously reported the beneficial effects of immediate enteral nutrition (EN) after esophageal cancer surgery. This randomized control study was conducted to determine whether immediate EN is beneficial or not for patients whose thoracic ducts were ligated, as well as those whose thoracic ducts were preserved.Patients and methods: Thirty-nine patients who underwent radical resection of the esophageal cancer entered this trial. After stratifying into two groups—patients whose thoracic ducts were preserved [D(+)] and those whose thoracic ducts were ligated [D(−)], they were randomly divided into two groups—the patients who received early EN and those who received parenteral nutrition (PN) followed by delayed enteral feeding. Thus, the number of patients in the D(+)-EN group, D(+)-PN group, D(−)-EN group and D(−)-PN group were 13, 12, 7 and 7, respectively. The mortality and morbidity rates, and several blood chemistries were compared between the EN groups and the PN groups.Results: Total lymphocyte count showed a significant early increase and serum c-reactive protein (CRP) was significantly decreased in the D(+)-EN group compared to the D(+)-PN group. However those differences were not observed between the D(−) groups. Serum total bilirubin was significantly decreased in the both EN groups compared to the PN groups. The mortality and morbidity rates were not different between the EN group and the PN group in the D(+) patients and also in the D(−) patients.Conclusions: Patients whose thoracic ducts were ligated did not obtain any other benefit from early enteral feeding except for bilirubin metabolism. Early enteral feeding is not recommended for patients whose thoracic ducts are ligated during radical resection of a cancer in the thoracic esophagus.     

重症急性胰腺炎完全胃肠外营养与肠外联合肠内营养治疗对比研究

目的 观察重症急性胰腺炎(SAP)完全胃肠外营养(TPN)与肠外营养(PN)联合肠内营养(EN)治疗中各项指标的变化,分析二者疗效.方法 29例SAP随机分为TPN组(14例)和PN+EN组(15例),并均行非手术治疗14 d,观察疗效及化验指标的变化.结果 营养支持治疗14 d后,各组血清白蛋白(ALB)、总蛋白(TSP)、血钙(Ca2+)、谷丙转氨酶(ALT)、谷草转氨酶(AST) 较营养支持前均显著升高(P<0.05);各组血糖、血清淀粉酶、血WBC均较营养支持前显著下降(P<0.05);各组血总胆红素(TB)治疗前后差异无统计学意义(P>0.05);PN+EN组血WBC显著低于TPN组(P<0.05),其余化验指标组间比较差异无统计学意义(P>0.05);各组APACHEⅡ评分较治疗前显著降低(P<0.05),PN+EN组评分显著低于TPN组(P<0.05).PN+EN组住院天数、住院总费用、感染发生率及死亡率均显著低于TPN组(P<0.05).结论 PN联合EN治疗SAP优于TPN.     

重症急性胰腺炎完全胃肠外营养与肠外联合肠内营养治疗对比研究

目的 观察重症急性胰腺炎(SAP)完全胃肠外营养(TPN)与肠外营养(PN)联合肠内营养(EN)治疗中各项指标的变化,分析二者疗效.方法 29例SAP随机分为TPN组(14例)和PN+EN组(15例),并均行非手术治疗14 d,观察疗效及化验指标的变化.结果 营养支持治疗14 d后,各组血清白蛋白(ALB)、总蛋白(TSP)、血钙(Ca2+)、谷丙转氨酶(ALT)、谷草转氨酶(AST) 较营养支持前均显著升高(P<0.05);各组血糖、血清淀粉酶、血WBC均较营养支持前显著下降(P<0.05);各组血总胆红素(TB)治疗前后差异无统计学意义(P>0.05);PN+EN组血WBC显著低于TPN组(P<0.05),其余化验指标组间比较差异无统计学意义(P>0.05);各组APACHEⅡ评分较治疗前显著降低(P<0.05),PN+EN组评分显著低于TPN组(P<0.05).PN+EN组住院天数、住院总费用、感染发生率及死亡率均显著低于TPN组(P<0.05).结论 PN联合EN治疗SAP优于TPN.     

肠内外营养支持治疗重症急性胰腺炎的临床对比分析

目的 对比肠内外营养支持方式对重症急性胰腺炎(SAP)患者的治疗作用,阐明肠内营养的优点.方法 59例SAP患者,分为全胃肠外营养(TPN)组24例及肠内营养(EN)组35例,分别检测分析两组的营养学指标,对比观察两组的治疗效果.结果 两组血清白蛋白、前白蛋白、转铁蛋白、血红蛋白治疗后与治疗前相比,均有改善(P<0.05);血清前白蛋白、转铁蛋白EN组与TPN组比较,差异有统计学意义(P<0.05).无论治疗后1周还是治疗后2周,APACHE Ⅱ评分EN组均低于TPN组(P<0.05).EN组的胰腺胰周感染率、其他并发症发病率、经口进食时间及治疗费用均低于TPN组(P<0.05),虽然病死率、住院天数两组间无统计学差异(P>0.05). 结论 EN可以改善SAP患者的营养状况,且具有保护肠黏膜屏障功能,减少细菌及毒素移位,调节炎症和感染反应,降低医疗费用等优点,是治疗SAP理想的营养支持方式.     

早期肠内营养在重症急性胰腺炎治疗中的应用

目的 观察早期肠内营养在重症急性胰腺炎（SAP）治疗中的临床疗效。方法 56例SAP患者,用随机数字表法分为肠内营养组（EN组,26例）和全胃肠外营养组（TPN组,30例）。结果 治疗第14天,EN组CD3⁺、CD4⁺、CD4⁺/CD8⁺,IgG、IgA、IgM值以及白蛋白均高于TPN组（P<0.05）;EN组IL-8、TNF、腹内压均显著低于TPN组（P<0.01）。EN组感染率、MODS发生率、28 d病死率和ICU住院时间均低于TPN组（P<0.05）。结论 早期肠内营养不仅可以调节SAP患者的免疫功能,抑制炎症反应,改善营养状况,而且减少了感染率。MODS发生率、ICU住院时间及28 d病死率。     

特殊营养膳对重症急性胰腺炎患者的血糖调控作用

目的探讨特殊营养膳对重症急性胰腺炎患者的血糖调控作用。方法将60例重症急性胰腺炎患者随机分为对照组和治疗组,分别给予常规营养膳及特殊营养膳。在不同时间监测急性期反应、胰腺病变、血糖变化、感染及其相关并发症的发生率、病死率和住院天数。结果两组急性期反应指标及胰腺病变无明显差异,但治疗组各时间点血糖平均水平及胰岛素用量、感染及其相关并发症的发生率及住院天数显著低于对照组,但病死率无显著差别。结论特殊营养膳能有效缓解重症急性胰腺炎急性期反应,通过对血糖的调控减少感染及其相关并发症的发生。     

Reevaluation of the Indications for Radical Pancreatectomy to Treat Pancreatic Carcinoma: Is Portal Vein Infiltration a Contraindication?

Abstract. Purpose: Portal vein resection (PVR) has become more widely performed owing to improvements in the perioperative mortality rate. The present study was performed to determine whether portal vein infiltration is a contraindication against radical pancreatectomy for patients with pancreatic carcinoma. Methods: Between 1990 and 1997, a total of 66 patients with invasive ductal carcinoma of the pancreas underwent surgical resection at the Department of Surgery II, Hokkaido University Hospital. After the exclusion of those who underwent distal pancreatectomy, the remaining 43 patients were divided into a PVR(+) group (n= 28) and a PVR(−) group (n= 15). The clinicopathological characteristics, morbidity, and mortality were statistically compared between the two groups. Results: The overall survival rate of the patients who required PVR was not significantly different from that of those who underwent pancreatic resection without PVR. Conclusion: These findings suggest that combined PVR should not be a contraindication to radical pancreatectomy for pancreatic carcinoma with positive vascular invasion. Received: February 26, 2001 / Accepted: November 20, 2001     

Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery

OBJECTIVES: We have previously reported the beneficial effects of immediate enteral nutrition (EN) after esophageal cancer surgery. This randomized control study was conducted to determine whether immediate EN is beneficial or not for patients whose thoracic ducts were ligated, as well as those whose thoracic ducts were preserved. PATENTS AND METHODS: Thirty-nine patients who underwent radical resection of the esophageal cancer entered this trial. After stratifying into two groups--patients whose thoracic ducts were preserved [D(+)] and those whose thoracic ducts were ligated [D(-)], they were randomly divided into two groups--the patients who received early EN and those who received parenteral nutrition (PN) followed by delayed enteral feeding. Thus, the number of patients in the D(+)-EN group, D(+)-PN group, D(-)-EN group and D(-)-PN group were 13, 12, 7 and 7, respectively. The mortality and morbidity rates, and several blood chemistries were compared between the EN groups and the PN groups. RESULTS: Total lymphocyte count showed a significant early increase and serum c-reactive protein (CRP) was significantly decreased in the D(+)-EN group compared to the D(+)-PN group. However those differences were not observed between the D(-) groups. Serum total bilirubin was significantly decreased in the both EN groups compared to the PN groups. The mortality and morbidity rates were not different between the EN group and the PN group in the D(+) patients and also in the D(-) patients. CONCLUSIONS: Patients whose thoracic ducts were ligated did not obtain any other benefit from early enteral feeding except for bilirubin metabolism. Early enteral feeding is not recommended for patients whose thoracic ducts are ligated during radical resection of a cancer in the thoracic esophagus.     

早期肠内营养治疗在重症急性胰腺炎中的应用

目的：观察早期肠内营养治疗重症急性胰腺炎（SAP）的安全性和疗效。方法：2008年1月-2014年1月6年期间收治的82例SAP患者按营养方式不同分为两组,每组41例,采用早期肠内营养治疗为EN组（即入院第3 d置入空肠营养管）;采用肠外营养治疗为PN组;比较2组患者的治疗效果、营养状况的改变以及住院费用,同时比较两组患者入院第3 d和第7 d血浆内毒素水平的变化以及血TNF-α变化。结果： EN组入院第7 d血浆内毒素水平及血TNF-α下降明显。PN组营养支持时间、住院天数、平均住院费用均高于EN组（P＜0.05）。结论：早期肠内营养治疗SAP能改善营养、维护肠道黏膜屏障、减轻炎症反应以及降低住院费用等。     

重症急性胰腺炎早期液体治疗策略的探讨

目的探讨重症急性胰腺炎(SAP)早期两种不同液体治疗策略对患者预后的影响。方法回顾性分析我院2000年1月至2011年11月期间收治的符合入选标准且达到液体治疗目标的97例SAP患者,2000年1月至2004年12月期间收治的患者采用传统的液体治疗方法(简称传统治疗组,n=34),2005年1月至2011年11月期间收治的患者采取的早期目标指导的液体治疗策略(简称早期目标治疗组,n=63),比较2组间急性生理与慢性健康状况Ⅱ评分(APACHEⅡ)、器官功能不全评分(Marshall)、多器官功能障碍综合征(MODS)发生率、胰腺感染率和住院病死率的差异。结果与传统治疗组相比,早期目标治疗组患者液体治疗后第3天时的APACHEⅡ和Marshall评分较传统治疗组明显降低(APACHEⅡ评分:7.38±4.01比11.35±4.27,P=0.011;Marshall评分:4.13±2.06比6.82±3.15,P=0.016)。另外,早期目标治疗组患者入院后7 d内MODS发生率、胰腺感染率和住院病死率也较传统治疗组有所降低(MODS:46.0%比61.8%,P=0.139;胰腺感染率:31.7%比44.1%,P=0.226;住院病死率:15.8%比23.5%,P=0.355),但其差异均无统计学意义。结论本研究有限的病例结果提示,早期目标指导的液体治疗可在一定程度上缓解SAP病情,但能否改善SAP患者预后有待临床进行前瞻性随机对照研究。     

重症急性胰腺炎早期应用肠内营养临床疗效分析

目的观察重症急性胰腺炎(SAP)患者早期肠内营养(EEN)治疗的疗效。方法将65例SAP患者随机分成EEN组(33例)和TPN组(32例)。EEN组患者采取早期EEN+TPN治疗,并逐渐减少TPN的用量,直至停止TPN;TPN组患者采取TPN治疗。观察2组患者腹痛的缓解时间、住院期间花去的费用、住院的天数以及是否出现并发症。结果:2组患者通过营养支持后EEN组的腹痛缓解时间、住院时间、花去费用以及并发症发生率均低于TPN组(P0.05)差异具有统计学意义。结论 EEN治疗可显著提高SAP患者的治愈率,降低感染率及并发症的发生,并缩短住院时间。     

Enteral versus Parenteral Nutrition after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in the English Literature

Background Although previous studies recommend the use of enteral nutrition (EN), the benefit of EN after elective gastrointestinal surgery has not been comprehensively demonstrated as through a meta-analysis. Our aim is to determine whether enteral nutrition is more beneficial than parenteral nutrition. Methods A search was conducted on Medline, Web of Science, the Cochrane Library electronic databases, and bibliographic reviews. The trials were based on randomization, gastrointestinal surgery, and the reporting of at least one of the following end points: any complication, any infectious complication, mortality, wound infection and dehiscence, anastomotic leak, intraabdominal abscess, pneumonia, respiratory failure, urinary tract infection, renal failure, any adverse effect, and duration of hospital stay. Results Twenty-nine trials, which included 2,552 patients, met the criteria. EN was beneficial in the reduction of any complication (relative risk (RR), 0.85; 95% confidence interval (CI), 0.74–0.99; P = 0.04), any infectious complication (RR, 0.69; 95% CI, 0.56–0.86; P = 0.001), anastomotic leak (RR, 0.67; 95% CI, 0.47–0.95; P = 0.03), intraabdominal abscess (RR, 0.63; 95% CI, 0.41–0.95; P = 0.03), and duration of hospital stay (weighted mean difference, −0.81; 95% CI, −1.25–0.38; P = 0.02). There were no clear benefits in any of the other complications. Conclusion The present findings would lead us to recommend the use of EN rather than PN when possible and indicated. The preliminary report of this work was presented in the poster session of the 46th Annual Meeting of the Society for Surgery of the Alimentary Tract at the Digestive Disease Week in Chicago on May 2005. There are no sources of support, including grants, fellowships, and gifts of materials.     

重症病人肠内营养支持治疗营养风险与临床预后相关性研究

目的 探究接受肠内营养（EN）支持的重症病人中营养风险与预后的相关性,分析高营养风险病人死亡相关因素。方法 二次分析一项中国多中心EN实施现状横断面观察性研究数据,根据改良营养获益评估（mNUTRIC）划分为高低营养风险组,比较两组病人28 d病死率差异,分析营养风险与28 d病死率的相关性,并在高营养风险人群中进行死亡危险因素分析。结果 共纳入1095例接受EN支持的重症病人,其中高营养风险组为443例,其28 d病死率为26.3%（114/443）,显著高于低营养风险组12.7%（84/662,P＜0.05）。经校正基线特征和临床相关因素后,多变量Logistic回归模型提示高营养风险（OR=2.09,95%CI 1.5~2.93;P＜0.01）与28 d死亡显著相关。在高营养风险人群中,喂养不耐受症状如恶心或呕吐（OR=3.46,95%CI 1.76~6.8;P＜0.01）和腹泻（OR=2.05,95%CI 1.04~4.04;P=0.038）均为28 d死亡危险因素。结论 在接受EN支持的重症病人中,高营养风险组死亡风险较低营养风险组更高,营养风险与不良预后显著相关,高营养风险人群中喂养不耐受症状对死亡有较高的预测价值。     

Surgical Treatment for Severe Acute Pancreatitis: Extent and Surgical Control of Necrosis Determine Outcome

In patients operated on for severe acute pancreatitis (SAP), the factors determining outcome remain unclear. From 1986 to 1998 a total of 340 patients with a diagnosis of SAP and in need of operative treatment were admitted to the intensive care unit (ICU) of a university hospital and a secondary care hospital. The mean APACHE II score on the day of admission was 16.1 (range 8–35). All patients required operative therapy. Among the 340 patients, 270 (79.4%) had to be reoperated: 196 patients (72.6%) underwent operative revisions on demand, and 74 (27.4%) patients had preplanned reoperation. The overall mortality was 39.1% (133 patients). Septic organ failure in 126 patients (37.1%) and myocardial infarction or pulmonary embolism in 7 patients (2%) were the causes of death. The patient’s age (p <0.0002), APACHE II scores at admission (p <0.0001), presence or development of (single or multiple) organ failure (p <0.002), infection (p <0.02) and extent (p <0.04) of pancreatic necrosis, and surgical control of local necrosis (p <0.0001) significantly determined survival. SAP that requires surgical treatment is associated with high in-hospital mortality. Surgical control of local necrosis is the precondition for survival. Advanced age of the patient, high APACHE II score at admission, development of organ failure, and the extent and infection of pancreatic necrosis influence the outcome.     

膳食纤维肠内营养对大鼠急性重症胰腺炎肠屏障功能的影响

目的探讨早期添加膳食纤维（dietary fiber,DF）、肠内营养（enteral nutrion,EN）对急性重症胰腺炎（severe acute pancreatitis,SAP）大鼠肠屏障功能的影响。方法SD大鼠32只,随机分成4组（n=8）：SAP组（A组）,EN组（B组）,膳食纤维肠内营养（fiber enteral nutrion,FEN）组（C组）和对照组即假手术组（D组）。采用逆行胰胆管注射3．5％牛磺胆酸钠溶液制成重症胰腺炎大鼠模型。A组和D组术后36h开始自由饮葡萄糖盐水;C组和B组术后36h开始空肠营养管分次注射肠内营养液。5d后再次麻醉大鼠,收集组织及血液标本;检测指标包括细菌移位率、胰腺病理评分、结肠组织形态学变化、血浆D-乳酸以及小肠黏膜固有层CD4^＋,CD8^＋和CD4^＋／CD8^＋比值等。结果SAP大鼠结肠黏膜萎缩,黏膜腺体稀疏。FEN组结肠黏膜形态变化好于EN组。FEN组细菌培养阳性率明显低于SAP组。FEN组血浆D-乳酸水平明显低于EN组。FEN组与EN组比较,胰腺病理学评分、CD4^＋、CD8^＋淋巴细胞数和CD4^＋／CD8^＋比值差异无统计学意义。结论添加DF的EN在维护SAP肠黏膜屏障、改善肠道免疫功能、防止细菌易位方面作用优于单纯EN。DF尚不能提高小肠局部免疫功能。     

重症胰腺炎手术时机和手术方式的选择

目的探讨重症胰腺炎（ＳＡＰ）最佳手术时机和手术方式。方法对１９８５年～１９９４年间收治的５０例ＳＡＰ患者手术时机、术式及病死率进行回顾性分析。结果（１）手术病死率为１４％,其中８５．７％为４０～６０岁年龄段患者。性别及病因分类无差异。（２）随手术距发病时间延长,病死率逐渐降低,但差异无显著性（Ｐ＞０．０５）。（３）随手术距入院时间延长,病死率明显降低,入院１２小时内手术者病死率显著高于其他时间组（Ｐ＜０．０１）。（４）随胰坏死程度及胰外器官受累个数增加,手术病死率显著增加（Ｐ＜０．０１及Ｐ＜０．０５）。（５）休克、胰坏死及多脏器功能衰竭（ＭＯＦ）的相关病死率分别为３１．８％、３１．６％和２８．０％（Ｐ均＜０．０５）。（６）术式以胆胰联合手术及单纯胰病灶清除引流为主。结论ＳＡＰ手术时机是影响手术病死率的重要因素,最佳时机的选择应与ＳＡＰ自然病程相适应,避免在发病后１～７天,尤其在入院１２小时内手术。强调术前给予至少２４小时支持治疗。术式选择应以简单有效,充分引流,清除病灶,去除病因为基本原则。     

Treatment of Acute Pancreatic Pseudocysts After Severe Acute Pancreatitis

Treatment of acute pancreatic pseudocysts (APP) after an episode of severe acute pancreatitis (SAP) remains controversial. Both population heterogeneity and limited numbers of patients in most series prevent a proper analysis of therapeutic results. The study design is a case series of a large, tertiary referral hospital in the surgical treatment of patients with APP after SAP. An institutional treatment algorithm was used to triage patients with complicated APP and organ failure based on Sequential Organ Failure Assessment scores to temporizing percutaneous or endoscopic drainage to control sepsis and improve their clinical condition before definitive surgical management. Over a 10-year period of study (December 1995 to 2005), 73 patients with APP after an episode of SAP were treated, 43 patients (59%) developed complications (infection 74.4%, perforation 21%, and bleeding 4.6%) and qualified for our treatment algorithm. Percutaneous/endoscopic drainage was successful in controlling sepsis in 11 of 13 patients (85%) with severe organ failure and allowed all patients to undergo definitive surgical management. The morbidity (7 vs 44.1%, P = 0.005) and mortality rates (0 vs 19%, P = 0.04) were significantly higher in complicated vs uncomplicated APP. Acute pancreatic pseudocysts after SAP are unpredictable and have a high incidence of complications. Once complications develop, there is a significantly higher morbidity and mortality rate. In complicated APP with severe organ failure, percutaneous/endoscopic drainage is useful in controlling sepsis and allowing definitive surgical management.     

早期血液净化联合早期肠道去污治疗重症急性胰腺炎的疗效观察

【摘要】〓目的〓观察早期血液净化联合早期选择性肠道去污治疗重症急性胰腺炎的疗效。方法〓回顾性分析2012年3月至2015年3月份入住ICU的39例重症急性胰腺炎患者的临床资料,按胰腺炎的干预措施分为干预组和对照组,在胰腺炎其他基础治疗的前提下,干预组为严格执行早期血液净化联合肠道去污治疗的病例,对照组为未早期执行血液净化和/或肠道去污治疗的SAP患者,比较两组患者治疗后膀胱压降至15 mmHg以下的时间、血管活性药物使用时间、呼吸机使用时间、ICU住院时间、平均住院费用、住院病死率等临床预后指标。结果〓与对照组比较,干预组患者患者膀胱压降至15 mmHg以下的天数明显下降(6±0.9 VS 8±1.8天,P<0.05),血管活性药物使用时间明显缩短,但使用呼吸机时间无明显差异,干预组比对照组患者ICU住院时间明显缩短(15±3.2 VS 23±4.6天,P<0.05),干预组的平均住院花费也明显降低(22±4.8 VS 31±7.3万元,P<0.05)。最终,干预组住院病死率为9.5%,治疗组为22.2%,两组比较差异有显著性。结论〓早期血液净化联合早期肠道去污治疗重症急性胰腺炎,能明显减轻患者的临床症状,改善预后。     

重症急性胰腺炎的早期非手术治疗

目的　探讨重症急性胰腺炎( SAP) 的早期治疗方法和合理方案。方法　对1 9 8 6年6月~ 2 0 0 4 年6 月收治的1 2 3例SAP患者按各个阶段治疗方法不同分为两组:A组1 9 8 6年6月~ 1 9 9 2年6月以手术治疗为主5 3 例,B组1 9 9 2年7月~ 2 0 0 4年6月以早期非手术治疗为主7 0例。结果　手术组(A)病死率3 3. 9% ( 1 8 /5 3 )。并发症发生率:ARDS2 8. 3% ( 1 5 /5 3 )、休克1 6. 9% ( 9 /5 3 ),肾衰竭2 0. 8% ( 1 1 /5 3 ), 胰腺脓肿1 6. 9% ( 9 /5 3 ) , 心功能不全2 4. 5% ( 1 3 /5 3 )。早期非手术组(B)病死率分别为7. 1% ( 5 /7 0 ) 。并发症发生率:ARDS1 4. 3% ( 1 0 /7 0 ),休克7. 1% ( 5 /7 0 ),肾衰竭7. 1% ( 5 /7 0 ), 胰腺脓肿2. 8% ( 2 /7 0 ) , 心功能不全4. 2% ( 3 /7 0 )。两组病死率及并发症率比较差异均有显著性(P< 0. 0 0 1 )。结论　急性重症胰腺炎采用早期非手术治疗能有效降低病死率和并发症发生率。大多数重症急性胰腺炎可经非手术治愈。     

联合营养支持对胰十二指肠切除术后病人肝功能和临床结局的影响

目的 比较胰十二指肠切除术后肠外营养(PN)联合肠内营养(EN)支持与单纯PN对病人术后肝功能与临床结局的影响.方法 回顾我院2002年1月至2007年12月接受胰十二指肠切除术(duodenopancreatectomy,PD)共109例的临床资料,其中56例术后接受PN联合EN营养支持(PN+EN组),53例单纯给...