胰头十二指肠切除术后肠内营养的早期应用

目的 研究肠内营养(enteral nutrition,EN)在Whipple手术后早期应用的价值.方法 对我院2001年1月至2003年3月施行的Whipple手术54例进行分组:A组26例为手术后EN支持,B组28例为手术后PN支持,两组进行对比研究.结果 A组EN为手术后3～5 d肠功能恢复时,用复尔凯<'R>800型肠内输液泵泵入营养制剂,其持续时间平均为9.35 d,B组PN持续时间13.19 d;术后胰瘘、胆瘘、感染A组分别为1例、0例、2例,B组分别为6例、2例、5例,A组无一例死亡;A组较B组缩短病程8.74 d;A组较B组节省住院费用7503.95元.结论 Whipple手术后早期EN支持治疗是安全可行的,有助于降低术后并发症及改善预后,缩短病程以及节省住院费用.     

胰腺癌病人胰十二指肠切除术后肠内营养的临床应用

胰十二指肠切除术（pancreatoduodenectomy,PD）是治疗胰腺恶性肿瘤最常见的手术,手术范围大,切除脏器多,术后并发症发生率在20％～60％．其中最常见的为胰肠吻合口漏、胃肠道出血、腹腔感染、胃排空延迟等。多数胰腺癌病人术前常合并不同程度的营养不良,术后机体处于高代谢状态．肝脏合成利用氨基酸的能力下降,机体蛋白分解加剧,易出现负氮平衡。     

胰十二指肠切除术后早期肠内营养对感染性并发症的影响

目的 探讨胰十二指肠切除术(PD)术后早期肠内营养(EN)对术后感染性并发症的影响.方法 收集我院2011年1月至2011年10月间行PD的患者共46例,回顾性分析术后早期EN和肠外营养(PN)对术后感染并发症的影响.结果 两组间比较,术后9d EN组内毒素和(1-3) -β-D葡聚糖明显低于PN组(P<(0.05);EN组术后腹腔感染和腹腔外感染总发生少于PN组(P<0.05);EN组术后吻合口并发症发生少于PN组(P<0.05).结论 PD术后早期行EN可以有效降低术后腹腔内感染、腹腔外感染、真菌感染和吻合口并发症发生率,改善预后.     

胰十二指肠切除术后肠内营养支持的临床应用

目的 探讨肠内营养（EN）支持对胰十二指肠切除术患者的临床效果。方法 回顾分析胰十二指肠切除术22 例病人的临床资料,采用术中置空肠造瘘管术后常规EN方法,观察EN实施后效果及并发症情况。结果 本组22例病人中,21例痊愈,1例死亡。痊愈患者中,未出现胰瘘和胃肠吻合口瘘,肠道功能均在 3～5d内恢复,并逐步恢复经口进食。术后出现胆瘘1例,经有效的引流后痊愈;肺部感染2例,经抗感染后治愈;1例死亡患者因胰瘘并腹腔感染致腹腔内反复出血而衰竭死亡。结论 采用空肠造瘘管进行胰十二指肠切除术后的EN支持治疗,方法简单易于掌握,效果良好。     

胰十二指肠切除术后早期肠内营养的意义

目的:探讨早期肠内营养对胰十二指肠切除术的影响。方法:对14例胰十二指肠切除术病人于术后早期进行肠内营养,观察营养指标的变化和手术并发症发生情况。结果:无死亡病例。肠内营养7d后,淋巴细胞总数、血清转铁蛋白较营养前有明显提高;术后病人28～56h肛门排气,发生胰瘘、切口感染各1例。结论:对胰十二指肠切除病人进行早期肠内营养是安全的,它可以有效地改善营养状况,增加免疫功能,降低手术并发症,促进术后病人顺利康复。     

胰十二指肠切除术后出血并发症处理

正张太平(中国医学科学院北京协和医院基本外科)文献报道胰腺手术后出血的发生率为7%～14%,是胰腺手术后最重要的致死原因,即使经验丰富的胰腺外科医生,在临床上也难以完全避免。按出血时间可分为早期出血和晚期出血,早期出血一般是指发生于术后24 h的出血,晚期出血是指发生在手术5～7 d后的出血;按出血部位可分为腹腔内出血和消化道出血;按出血的严重程度可分为轻度、中度、重度。     

胰十二指肠切除术后早期肠内营养支持

2001年2月～2003年12月我院在胰十二指肠切除术后采用肠内营养，改善患者体质，提高抗病能力预防并发症的发生，收到良好效果，现报道如下。     

胰十二指肠切除术后肠内营养不耐受的防治策略

胰腺癌是恶性程度极高的消化道肿瘤,手术是唯一可能的根治性治疗手段。胰十二指肠切除术后患者营养不良发生率较高,规范、合理、科学地使用肠内营养治疗,对胰腺癌患者术后恢复有着重大意义。本文基于近年来胰十二指肠切除术后肠内营养的现状和研究发展趋势做简要概述,为胰腺癌术后的肠内营养治疗提供参考。     

胰十二指肠切除术后外科相关并发症的分析与处理

目的 探讨胰十二指肠切除术后外科相关并发症发生的原因与处理措施.方法 回顾性研究1995年1月至2010年4月共412例行胰十二指肠切除术患者的临床资料,男性232例,女性180例,分析其术后并发症发生的影响因素与治疗方法.结果 本组中共有153例患者出现并发症214例次,总发生率为37.1%.术后30 d内死亡19例,总病死率4.6%.统计学分析显示,胰腺钩突全切除与否(P=0.022)、胰肠吻合方式(P=0.005)、胰管直径(P=0.007)及残余胰腺质地(P=0.000)与胰瘘的发生具有相关性;未进行胰腺钩突全切除(P=0.002)、术中失血量≥600ml(P=0.000)及合并胰瘘者(P=0.000)术后出血发生率显著增高;保留幽门的胰十二指肠切除术组术后胃排空障碍的发生率显著高于传统胰十二指肠切除术组(P=0.000).多因素Logistic回归分析表明,胰管直径及胰腺质地是影响胰瘘发生的独立危险因素;未进行胰腺钩突全切除、术中失血量≥600ml及胰瘘为影响术后出血的独立危险因素;联合血管切除或腹膜后淋巴清扫的患者与未行血管切除或腹膜后淋巴清扫的患者相比,并发症发生率的差异无统计学意义(P＜0.05).结论 合并慢性胰腺炎及胰管扩张的患者可行胰肠端侧黏膜对黏膜吻合,而端端或端侧套入式吻合更适于胰管不扩张或胰腺质软者;完整切除钩突、术中仔细止血是预防术后出血的重要因素;胰瘘是并发术后出血的重要原因之一.联合肠系膜上静脉或门静脉切除及腹膜后淋巴结清扫不会增加术后并发症的发生率.     

肠内营养与肠内营养联合肠外营养在胰十二指肠切除术后患者中的应用比较

目的比较肠内营养(EN)、EN联合肠外营养(PN)在胰十二指肠切除术(PD)后患者中的应用。方法回顾性分析2005年1月~2014年1月我院87例PD后患者的临床资料,根据术后营养方式分为EN组(37例)及EN+PN组(50例),比较两组患者术后恢复情况、手术及术后营养相关并发症发生率、血生化相关性指标。结果两组患者术后恢复情况及手术相关并发症发生率比较,差异无统计学意义(P0.05),EN组与EN+PN组营养支持相关并发症率分别为30%、12%,差异有统计学意义(P0.05),EN+PN组血清总胆红素、丙氨酸转氨酶高于EN组(均P0.05),但两组均在正常值范围内。结论 PD患者术后应用EN联合PN安全性及实用性均与单独应用EN相似,但可明显减少营养相关并发症,是PD术后更好的营养方式。     

Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy

The aim of this study was to prospectively analyze the possible association of delayed gastric emptying and postoperative pancreatic complications after pancreaticoduodenectomy. Although hospital mortality after pancreaticoduodenectomy is minimal, morbidity is still high; delayed gastric emptying is one of the most frequent complications. Thirty-nine consecutive patients undergoing pancreaticoduodenectomy were included in this study: 14 females and 25 males (median age 65 years; range, 7–82). Delayed gastric emptying was defined as the need for a nasogastric tube or recurrent vomiting that prevented normal feeding on the 10th postoperative day. Blood analysis was performed on postoperative days 4, 6, and 10; Gastrografin examination on day 6; CT scan on days 2 and 5; and drain amylases were measured on day 5. Pancreatitis was defined as pancreatitis changes in CT scan interpreted by an experienced radiologist without knowing other data. Pancreatic fistula was defined according to the recent international recommendations. We had no mortality. Twelve patients (31%) developed delayed gastric emptying. Surgical (9/12 vs. 5/27; P=0.001) but not medical complications occurred more often in the delayed gastric emptying group. Of the single complications, postoperative CT-detected pancreatitis (6/12 vs. 4/27; P=0.03) and postoperative pancreatic fistula (5/12 vs. 1/27; P=0.0007) were significantly associated with delayed gastric emptying compared with the patients without delayed gastric emptying. This pancreatitis was already detected in CT scan on day 2 in most patients (6/10, 60%). In delayed gastric emptying patients, the only parameters in blood analysis that differed significantly from patients without this complication were serum amylase activity (mean±SEM, 715±205 vs. 152±70 IU/L; P=0.02), blood leukocyte count (16±2 vs. 9±0.6 × 10⁹/L; P=0.007) and serum C-reactive protein (CRP) concentration (144±28 vs. 51±14 mg/L, P=0.01). Postoperative pancreatic (subclinical) fistula was also associated with postoperative pancreatitis (6/10 vs. 0/29; P=0.003). Preoperative coronary artery disease (OR=16; 95% CI, 1.0-241; P=0.05) and soft pancreatic texture at operation (OR=9; 95% CI, 1.4-52; P=0.02) were significant risk factors for the development of postoperative pancreatitis. The diagnosis of delayed gastric emptying after pancreaticoduodenectomy often follows postoperative pancreatitis. Delayed gastric emptying is also associated with postoperative pancreatic fistula, for which this pancreatitis seems to be a risk factor. Preoperative coronary artery disease and soft texture of the pancreas are significant risk factors for postoperative CT-detected pancreatitis. Supported by the Medical Research Fund of Tampere University Hospital, Pirkanmaa Hospital District, Finland (S.R.).     

腹腔镜胰十二指肠切除术后胃排空延迟原因分析及处理

目的 探讨腹腔镜胰十二指肠切除术（LPD）后胃排空延迟（DGE）发生原因及处理要点。方法 回顾性分析2017年3月至2021年11月山东第一医科大学附属省立医院器官移植肝胆外二科832例行LPD病人临床资料,根据是否发生DGE分为DGE组和无DGE组,比较两组病人临床特征,logistic回归分析DGE发生的危险因素,评估不同处理方式的效果。结果 共有194例（23.3%）术后发生DGE。与无DGE组比较,DGE组术前低白蛋白血症病例多,手术时间长,术中出血量多,行改进前胃空肠吻合和术中输血例数多,术后并发症发生率高,其中Clavien-Dindo分级≥Ⅲa级并发症,胆漏,B、C级胰瘘和腹腔感染发生率高于无DGE组。多因素logistic回归分析发现术前低白蛋白血症、术中输血和腹腔感染是任意级别DGE发生的独立危险因素;其中术中输血、胰瘘、胆漏和腹腔感染是B、C级DGE发生的独立危险因素。B、C级DGE 62例,48例存在腹腔感染合并吻合口漏,其中42例接受腹腔穿刺引流,6例持续内冲洗负压引流,均取得良好治疗效果。结论 DGE多继发于术后吻合口漏及腹腔感染,术前纠正低白蛋白血症、合理的...     

全胃切除患者术后早期强化免疫营养的临床效果分析

目的观察术后早期强化肠内免疫营养对全胃切除术患者的临床效果。方法全胃切除术后胃癌患者120例,所有患者均曾合并术前营养不良,其中60例患者术后早期接受普通肠内营养(EN组),另外60例接受强化的肠内免疫营养(EIN组)。分别于术前1天、术后第1天、术后第8天检测两组患者的营养指标(血清白蛋白、前白蛋白和转铁蛋白)及免疫指标(血清IgA、IgG、IgM和外周血T淋巴细胞亚群),并观察术后感染性的发生率。结果术前两组问各营养指标比较无显著性差异(P0.05);两组患者术后第1天的各项营养指标和免疫指标较术前均显著下降(P0.05);两组患者术后第8天的营养指标和免疫指标较术后第1天均有改善,且EIN组患者的各项免疫指标均高于EN组(P0.05),两组间营养指标比较无统计学差异(P0.05);EIN组术后感染性的发生率较EN组低(P0.05)。结论术后早期肠内免疫营养能更好地改善全胃切除术后患者的免疫状态,并降低术后感染性发生率。     

Complications associated with enteral nutrition using catheter jejunostomy after esophagectomy

The present study was conducted on 78 patients, encountered over a 7-year period, who had a catheter-feeding jejunostomy placed at the time of thoracoabdominal esophagectomy for esophageal cancer. A broad-based attachment of the jejunal wall to the peritoneum at the place of entry of the catheter was used. Enteral nutrition was begun an average of 10 days after the operation, the caloric content was increased gradually, and the mean duration was 69 days. There were three patients who suffered from local skin erosion at the site of catheter entry, and seven who developed diarrhea and/or a feeling of abdominal fullness, but none of the patients showed any signs of peritonitis or ileus. The morbidity rates related to enteral nutrients and placement of the catheter jejunostomy were 8.9% and 3.8%, respectively. These findings demonstrate that a broad-based attachment of the jejunal wall to the peritoneum at the place of entry of the catheter is useful for preventing leakage or twisting of the jejunum, and for reducing the incidence and severity of the complications of catheter jejunostomy feeding.     

胰十二指肠切除术后腹腔并发症发生及引流留置时间预测

目的 研究分析胰十二指肠切除术后严重腹腔内并发症发生及引流留置时间的相关预测因素.方法 回顾性分析我院2010年1月至2013年12月施行的113例胰十二指肠切除术后患者腹腔内严重并发症发生与术后炎症反应持续时间、腹腔引流液淀粉酶水平等因素之间的关系.结果 在无并发症组及A级胰瘘组患者中,腹腔引流液淀粉酶值出现平稳降低,且经历较短时间的术后炎症反应（1.7±2.4）d;而在严重并发症组患者中,腹腔引流液淀粉酶值自术后第3天开始出现持续性升高,并且经历较长时间的术后炎症反应（4.5±4.4）d.结论 通过结合患者引流液淀粉酶值变化趋势及术后炎症反应天数等指标可以早期预测腹腔内严重并发症发生情况,为临床确定引流管拔除时机及制定相应治疗方案提供依据.     

Postoperative jejunal feeding and outcome of pancreaticoduodenectomy

Complications following pancreaticoduodenectomy are common, partly because of nutritional debilitation. The aim of this study was to evaluate the impact of early postoperative tube feeding on outcome of pancreaticoduodenectomy and determine the best method for delivering enteral feeding. A retrospective review of 180 consecutive patients undergoing Whipple operations from 1994 to 2000 was performed. Two nonrandomized patient groups were retrospectively studied: those with early postoperative tube feeding vs. those with no planned feeding. Ninety-eight patients (54%) received postoperative jejunal feeding, whereas 82 patients (46%) did not. Jejunal feeding was delivered via a bridled nasojejunal tube in 55 patients (56%) and a gastrojejunal tube in 43 (44%). Vomiting (10% vs. 29%; P = 0.002) and use of total parenteral nutrition (6% vs. 27%; P < 0.0001) were less in the jejunal feeding group as well as rates of readmission (12% vs. 27%; P= 0.022), early (52% vs. 62%; P = 0.223) and late (12% vs. 31%, P = 0.005) complications, and infections (13% vs. 20%, P = 0.014). Tube-related complications occurred in 6 of 98 patients, all of which were associated with gastrojejunal tubes (P = 0.021). Early postoperative tube feeding after pancreaticoduodenectomy is associated with significantly less use of total parenteral nutrition and lower rates of readmission and complications. A bridled nasojejunal feeding tube appears to be a safe and reliable method of short-term enteral feeding. Presented at the 2003 meeting of the Americas Hepato-Pancreato-Biliary Congress, Miami Beach, Florida, February 27–March 2, 2003.     

胃癌术后早期肠内营养支持的研究

目的：观察早期肠内营养（EEN）对胃癌患者术后恢复的影响。方法：将100例胃癌根治术后患者随机分为EEN组和肠外营养（PN）组,每组50例。2组均于术后第1天和第2天给予1/3、2/3目标量,第3- 8天维持目标量,2组患者基本等氮、等热量。于手术前1 d和术后第9天检测患者血清白蛋白（ALB）、转铁蛋白（TF）、前白蛋白（PA）、ALT、AST、总胆红素（TB）、CD3、CD4、CD8和CD4/CD8,记录营养支持不良反应发生率、胃肠道功能恢复时间、感染性并发症发生率、营养支持费用和住院天数。结果：EEN组和PN组的营养指标（ALB、TF、PA）及肝功能指标（ALT、AST、TB）差异无统计学意义（P〉0.05）,但EEN组的免疫指标（CD3、CD4、CD4/CD8）高于PN组（P〈0.05）。EEN组和PN组营养支持不良反应的发生率差异无统计学意义（P〉0.05）。EEN组胃肠道功能恢复时间早于PN组（P〈0.01）。EEN组感染性并发症的发生率低于PN组（P〈0.05）,EEN组营养支持费用和住院时间均少于PN组（P〈0.01）。结论：胃癌患者术后EEN比PN更为安全、经济、有效。