腹腔镜辅助全胃切除术后不同途径早期肠内营养的对比研究

目的：比较空肠造瘘管与鼻空肠营养管在腹腔镜辅助全胃切除术后患者行肠内营养治疗的临床效果。方法选取2010年6月至2016年3月本院收治的腹腔镜辅助全胃切除术后拟行肠内营养治疗的112例患者，根据肠内营养途径的不同分为试验组（空肠造瘘管组55例）和对照组（鼻空肠营养管组57例），比较两者的手术时间、术后恢复情况、营养状况及并发症发生率。结果试验组的手术时间显著长于对照组（21．4±4．38）分钟vs．（4．70±1．30）分钟，t＝27．55，P＜0．01]；肛门恢复排气时间、排便时间均明显短于对照组（均P＜0．05）；两组术后1周的血红蛋白、淋巴细胞、血清白蛋白均无明显差异（均P＞0．05）；两组并发症发生率中穿刺口疼痛、鼻咽部不适、导管堵塞、肺部感染、导管移位均有显著性差异（均P＜0．05）。结论在腹腔镜辅助全胃切除术后患者中经空肠造瘘管给予肠内营养治疗与经鼻空肠营养管途径相比，术后恢复较快，且不易堵塞、移位及造成误吸，适用于早期并需要较长时间进行肠内营养支持的胃癌术后患者。

Clinical research of different nutritional support routes for early enteral nutrition after laparoscopic assisted total gastrectomy

Objective Compare the clinical efficacy and safety of feeding jejunostomy tube and feeding nasojejunal tube in patient underlaparoscopic assisted total gastrectomy. Methods From June 2010 to March 2016,112 patients received laparoscopic assisted total gastrectomy in our hospital were randomly divided into the observation group (the feeding jejunostomy tube group 55 cases) and the control group (feeding nasojejunal tube 57 cases). Clinical outcomes including the recovery postoperative time, the nutritional state, and the feeding tube related complications were compared. Results The operative time of the observation group was longer than the control group(21.4±4.38)min vs. (4.70±1.30)min,t=27.55,P<0.01]. The recovery of digestive system was faster than the control groups (all P<0.05). There was no significant difference in hemoglobin , lymphocyte and serum albumin between the two groups at one week after operation (all P> 0.05). The related complication rate of the feeding tube were significant different between the two group in pain of puncture site, rhinopharyngeal discomfort, obstruction of the tube, pulmonary infection, and tube translocation (all P<0.05). Conclusions Compared to nasojejunal feeding tube, the jejunostomy feeding tube get faster recovery and seldom obstruction or translocation or aspiration pneumonia, which is more suitable to the patients who need early and longtime enteral nutrition support.