Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

BackgroundPatients undergoing esophagectomy often receive jejunostomy tubes (j-tubes) for nutritional supplementation. We hypothesized that j-tubes are associated with increased post-esophagectomy readmissions.Study designWe identified esophagectomies for malignancy with (EWJ) or without (EWOJ) j-tubes using the 2010–2015 Nationwide Readmissions Database. Outcomes include readmission, inpatient mortality, and complications. Outcomes were compared before and after propensity score matching (PSM).ResultsOf 22,429 patients undergoing esophagectomy, 16,829 (75.0%) received j-tubes. Patients were similar in age and gender but EWJ were more likely to receive chemotherapy (24.2% vs. 15.1%, p < 0.01). EWJ was associated with decreased 180-day inpatient mortality (HR 0.72 [0.52–0.99]) but not with higher readmissions at 30- (15.2% vs. 14.0%, p = 0.16; HR 0.9 [0.77–1.05]) or 180 days (25.2% vs. 24.3%, p = 0.37; HR 0.94 [0.79–1.10]) or increased complications (p = 0.37). These results were confirmed in the PSM cohort.ConclusionJ-tubes placed in the setting of esophagectomy do not increase inpatient readmissions or mortality.     

经皮内镜下胃或空肠造瘘术治疗肠道功能衰竭患者的临床意义

目的 评估经皮内镜下胃或空肠造瘘术对肠道功能衰竭患者进行胃肠内营养支持后一些临床指标的变化的研究价值。方法74例肠功能衰竭患者按随机数表法分为造瘘组37例和鼻饲组37例,造瘘组接受内镜下胃或空肠造瘘术后进行胃肠内营养支持,鼻饲组经鼻胃管进行胃肠内营养支持并且治疗14天,最后比较两组患者血红蛋白、血清白蛋白、C反应蛋白、胃肠道功能评分和便血等指标变化,以及对比两组不良反应发生情况。结果 治疗后造瘘组的便血、胃肠道功能评分及血清白蛋白指标明显优于鼻饲组,差异均有统计学意义(P<0.05),而血红蛋白、C反应蛋白变化与鼻饲组相比差异无明显统计学意义(P>0.05),两组患者恶心呕吐、腹胀、腹泻不良反应发生情况相比差异无明显统计学意义(P>0.05)。结论 在临床应用中内镜下胃或空肠造瘘术行胃肠内营养支持对改善肠功能衰竭患者营养状况,尤其在提升血清白蛋白,减少患者便血情况及提升患者胃肠道功能具有一定的优势。     

上消化道重建术后鼻饲与空肠造口置管肠内营养临床效果比较的Meta分析

目的系统评价经鼻肠内营养管(NJT)与空肠造口置管(JT)两种不同营养途径在上消化道改建术后病人肠内营养的临床效果。方法计算机检索PubMed、EMbase、Web of science、The Cochrane Library(2015年第9期)、中国生物医学文献数据库(CBM)、中国知网、维普、万方数据等数据库,查找所有比较术后NJT与JT行肠内营养的上腹部肠道改建手术的随机对照试验(RCT),检索时限为从建库至2015年9月。由2位研究者按纳入与排除标准独立筛选文献、提取资料和评价文献质量后,进行Meta分析。结果最终纳入7个RCT,包括544例病人。Meta结果显示:虽然JT组术后总并发症发生率少于NJT组[RR=0.58,95%CI(0.38,0.90),P=0.02],但与管道相关并发症发生率两组差异无统计学意义[RR=1.30,95%CI(0.93,1.81),P=0.12];两组肠内营养置管后不能耐受发生率差异无统计学意义[RD=-0.08,95%CI(-0.20,0.03),P=0.16];术后主要并发症吻合口漏及肺炎两组差异无统计学意义(P0.05);肠功能恢复时间JT组明显短于NJT组[SMD=-1.19,95%CI(-1.77,-0.60),P0.0001],两组比较差异有统计学意义。结论两种肠内营养途径均是安全有效的方法,但JT在促进肠功能恢复和减少术后总并发症方面更有优势。     

Copper-deficiency anemia after esophagectomy: A pitfall of postoperative enteral nutrition through jejunostomy

INTRODUCTION

Copper deficiency leads to functional disorders of hematopoiesis and neurological system. There have been some reports of copper deficiency occurring to the patients on enteral nutrition through a jejunostomy in long-term-care hospitals. However, it is extremely rare to find patients with copper deficiency several months after esophagectomy, regardless of enteral nutrition through the jejunostomy. To the best of our knowledge, this is the first case report of a patient who experienced copper-deficiency anemia after esophagectomy and subsequent enteral nutrition through the jejunostomy.

PRESENTATION OF CASE

A 73-year-old man presented with pulmonary failure after esophagectomy for esophageal cancer with video-assisted thoracoscopic surgery, and needed long-term artificial ventilator support. Nutritional management included enteral nutrition through a jejunostomy from the early postoperative period. Copper-deficiency anemia was detected 3 months postoperatively; therefore, copper supplementation with cocoa powder was performed, and both serum copper and hemoglobin levels subsequently recovered.

DISCUSSION

Copper-deficiency anemia has already been reported to occur in patients receiving enteral nutrition in long-term care hospitals. However, this is the first case report of copper deficiency after esophagectomy despite administration of standard enteral nutrition through the jejunostomy for several months.

CONCLUSION

It is extremely rare to find copper-deficiency anemia several months after esophagectomy followed by enteral nutrition through the jejunostomy. However, if anemia of unknown origin occurs in such patients, copper-deficiency anemia must be considered among the differential diagnoses.     

经皮内镜胃造瘘和空肠造瘘术研究进展

经皮内镜胃造瘘(PEG)和空肠造瘘术(PEJ)人工肠内营养可有效避免患者营养状况进一步恶化,提高患者生活质量。随着对治疗目的更清晰的认识以及内镜技术的进步,PEG/PEJ适应证增加而禁忌证相对减少,操作技术及并发症防治研究有了许多进展。     

经皮内镜下胃造口、空肠造口及十二指肠造口120例临床分析

目的　探讨经皮内镜下胃造口、空肠造口及十二指肠造口的技术操作及适应证。方法2 0 0 1年 5月— 2 0 0 4年 4月间 ,共行 12 0例经皮内镜下胃肠造口 ,其中 75例经皮内镜下胃造口 (PEG) ,4 2例经皮内镜下空肠造口 (PEJ) ,2例经皮内镜下十二指肠造口 (PED) ,1例直接法经皮内镜下空肠造口(DPEJ)。操作均采用经典经腹壁拉出法技术。结果　采用上述方法共行长期肠内营养 88例 ;胃肠减压 2 5例 ;肠内营养联合胆汁回输 5例 ;围手术期应用PEG 2例 ,术前行胃肠减压 ,术后行长期肠内营养。PEG操作时间平均 (9± 4 )min ,PEJ平均 (17± 6 )min ,DPEJ为 2 0min ,2例PED分别为 10和 12min。技术成功率 98 4 % (12 0 / 12 2 )。严重并发症发生率为 0 8% (1/ 12 0 ) ,轻微并发症发生率为 7 5 %(9/ 12 0 )。结论　经皮内镜下胃肠造口操作简便、有效 ,并发症少。     

Bronchobiliary Fistula Treated by Self-expanding ePTFE-Covered Nitinol Stent-Graft

A 71-year-old man, who had undergone right hepatectomy extended to the caudate lobe with terminolateral Roux-en-Y left hepatojejunostomy for a Klatskin tumor, developed bilioptysis 3 weeks postoperatively due to bronchobiliary fistula. Percutaneous transhepatic cholangiography revealed a non-dilated biliary system with contrast medium extravasation to the right subphrenic space through a resected anomalous right posterior segmental duct. After initial unsuccessful internal-external biliary drainage, the fistula was sealed with a VIATORR covered self-expanding nitinol stent-graft placed with its distal uncovered region in the hepatojejunal anastomosis and the proximal ePTFE-lined region in the left hepatic duct. A 10-month follow-up revealed no recurrence of bilioptysis and confirmed the complete exclusion of the bronchobiliary fistula.     

穿刺式空肠造瘘术在腹部大手术中的应用与护理

目的：探讨危重患者术后穿刺式空肠造瘘术肠内营养的护理经验。方法：对48例危重患者术中经空肠穿刺放置nocare可裂式空肠造瘘管（穿刺式空肠造瘘术），术后早期经造瘘管行肠内营养，观察患者肠内营养时胃肠道及造瘘管的并发症。结果：48例患者空肠造瘘管应用良好，4例患者发生导管阻塞，在介入引导下用导丝予以疏通后重新应用；穿刺处无红肿和炎性渗出及其他造瘘管相关发并症，均在7—28天内拔除造口管。结论：穿刺式空肠造瘘术可用于腹部大手术后患者早期肠内营养，心理护理、完善的营养计划、造瘘管的护理及观察营养时可能出现的并发症等良好细致的护理是成功实施肠内营养的保证。