腹腔镜辅助结直肠癌术后早期经口进食的安全性观察

目的观察腹腔镜辅助结直肠癌术后早期经口进食的安全性及对临床结局的影响。方法选择2012年3月至2013年3月间东南大学医学院附属徐州医院胃肠外科收治的接受腹腔镜辅助结直肠癌手术治疗的患者120例,随机分为早期进食组及传统进食组,各60例,比较两组患者术后恢复情况、营养状况及并发症发生率。结果 103例完成试验,其中早期进食组58例,传统进食组45例,早期进食组与传统进食组术后首次排气时间（51.8±11.0）h vs（64.2±12.3）h,t=-5.39,P=0.000]、排便时间（65.9±8.5）h vs（73.2±13.7）h,t=-2.94,P=0.004]、住院费用（42.88±5.46）千元vs（46.25±7.73）千元,t=-2.35,P=0.021]相比,差异均有统计学意义;术后第7天早期进食组的白蛋白及前白蛋白水平均高于传统进食组,差异有统计学意义（P〈0.05）,两组患者住院时间、吻合口瘘、肺部感染、切口感染、胃潴留及腹泻等并发症发生率差异均无统计学意义,患者早期经口进食耐受率为86.21%（50/58）。结论腹腔镜辅助结直肠癌术后早期经口进食安全有效,能促进肠道功能恢复、改善患者营养状况。

Safety of early oral feeding after laparoscopic surgery of colorectal cancer

Objective To investigate the safety and clinical outcomes of early oral feeding after laparoscopic surgery of colorectal cancer. Methods A randomized controlled clinical trial was conducted from March 2012 to March 2013 in the Department of Gastrointestinal Surgery, Xuzhou Hospital, Medical College of Southeast University. A total of 120 patients with colorectal cancer undergoing laparoscopic surgery were randomly divided into early oral feeding group（60 cases） and conventional oral feeding group（60 cases）. Clinical parameters, markers of nutrition and postoperative complications were evaluated in both groups postoperatively. Results One hundred and three patients eventually completed the study, including 58 cases in early oral feeding group and 45 cases in conventional oral feeding group. Compared to the conventional oral feeding group, the first postoperative time of flatus was significantly shorter in the early oral feeding group （51.8±11.0） h vs（64.2±12.3） h, t=-5.39, P=0.000], as were the first passage of stool （65.9±8.5） h vs（73.2±13.7） h, t=-2.94, P=0.004], and medical cost （42 880±5 460） RMB vs（46 250±7 730） RMB, t=-2.35,P=0.021]. The levels of albumin and prealbumin were significant higher in the early oral feeding group as compared to the conventional oral feeding group on the 7th postoperative day（P〈0.05）. The differences of length of hospital stay, anastomotic leakage, pulmonary infection, wound infection, gastric retention and diarrhea were not statistically significant between the two groups. The rate of early oral feeding reached as much as 86.21 %（50/58）.Conclusions Early oral feeding after laparoscopic surgery of colorectal cancer is safe and effective. It can promote the intestinal function recovery and improve the nutritional status.