腹腔镜与开腹胃癌根治术后早期肠内营养的对比研究

目的 :探讨腹腔镜和开腹胃癌根治术对术后早期肠内营养(EEN)的影响。方法 :将2015年1月至2016年12月安徽医科大学附属安庆医院普外科68例胃癌病人随机分成两组,其中开腹手术组35例,腹腔镜手术组33例,两组术后均实施EEN,观察指标:⑴两组手术及其并发症的情况,⑵EEN的耐受性,⑶术后营养状态,⑷术后化疗开始时间。结果 :⑴两组手术时间,淋巴结清扫数目,术后并发症(吻合口瘘、肺部感染、切口感染)无差异(P0.05);腹腔镜组较开腹组术中出血量少(P0.01)。⑵EEN的耐受情况:腹腔镜组腹胀、腹泻等不适反应少于开腹组(P0.01),达到TEN的时间少于开腹组(P0.01)。⑶术后营养状态:术后第7天,腹腔镜组较早出现了营养状态改善,两组间前白蛋白、C反应蛋白水平差异有统计学意义(P0.01);术后第14天,腹腔镜组营养状态改善明显,两组间体质量、右上臂肌周径、白蛋白等营养指标差异均有统计学意义(P0.05)。⑷腹腔镜组进展期胃癌病人在术后45 d内接受化疗例数明显多于开腹组。结论:腹腔镜胃癌手术减小了手术创伤,能更好地耐受EEN,更早地达到TEN,从而有利于改善术后营养状态,为辅助化疗提供良好条件。

Comparative study of early enteral nutrition between laparoscopic and open distal gastrectomy

Objective:To investigate the effect of early postoperative enteral nutrition (EEN) on laparoscopic and open radical gastrectomy.Methods:From January 2015 to December 2016,68 patients with gastric cancer admited in Anqing Hospital,Anhui Medical University,were randomized into laparoscopic group (33 cases) and open group (35 cases).The following parameters were collected:(1) Surgical outcomes and complications;(2) EEN tolerance;(3) postoperative nutritional status;(4) starting time of postoperative chemotherapy.Results:There was no significant difference between groups in terms of operation time,number of lymph node,postoperative complications such as anastomotic fistula,pulmonary infection,incision infection (P ＞ 0.05);whereas the intraoperative blood loss was significantly less in laparoscopic group (P ＜ 0.01).(2) EEN tolerance:Postoperative discomforts,such as abdominal distension,diarrhea and other symptoms occurred significantly less in laparoscopic group (P ＜ 0.01),and time for TEN is significantly shorter (P ＜ 0.01).(3) Postoperative nutritional status:On the 7th day after operation,the nutrition status of the laparoscopic group improved earlier.There was significant difference regarding the detected blood level of prealbumin and C-reactive protein between the two groups (P ＜ 0.01).On the 14th day after operation,the nutritional status of the laparoscopic group improved significantly.The body weight,the right upper arm muscle circumference and the albumin were significantly different between two groups (P ＜ 0.05).(4) The number of cases receiving chemotherapy in patients with advanced gastric cancer was significantly higher in laparotomy group than that with open distal gastrectomy.Conclusion:Laparoscopic surgery for gastric cancer reduces surgical trauma,and leads to better EEN tolerance and earlier achieved TEN,which is conducive to improving postoperative nutritional status,as well as providing good conditions for adjuvant chemotherapy.