肠内营养制剂在直肠癌根治术前肠道准备中的应用

目的探讨直肠癌手术前使用肠内无渣整蛋白营养制剂替代传统机械肠道准备的可行性与安全性。方法前瞻性入组2011年6月至2012年3月间在中山大学附属第一医院胃肠胰外科行Dixon手术的直肠癌患者．采用完全随机1：1配对方法，将入组患者分为试验组和对照组．每组各30例。试验组患者术前连续3d口服无渣整蛋白肠内营养制剂，不行机械肠道准备：对照组术前口服泻药行机械肠道准备。比较两组患者术中及术后一般情况、肠道清洁程度、术后并发症及营养状况。结果两组患者的临床病理特征的差异均无统计学意义（均P〉0．05）。两组患者肠道清洁情况、手术时间、术中出血量及术后住院时间的差异均无统计学意义（均P〉0．05）；但试验组较对照组患者术后肛门排气时间（2．53±0．91）d比（3．03±0．68）d，P〈0．05]和半流饮食时间（3．95±0．83）d比（4．52±1．14）d，P〈0．05]明显缩短。两组均无围手术期死亡患者，术后并发症发生率的差异无统计学意义16．7％（5／30）比20．0％（6／30），P〉0．05]。两组患者术后总蛋白、白蛋白及前白蛋白水平较术前明显下降（均P〈0．05）；但试验组较对照组患者白蛋白（36．2±2．5）g／L比（33．5±2．6）g／L，P〈0．01]和前白蛋白（325．4±28．2）mg／L比（302．5±34．2）mg／L，P〈0．01]水平明显升高。结论直肠癌患者术前服用肠内营养制剂以代替术前机械肠道准备，其清肠效果并不劣于传统方法，亦不增加手术风险，并能有效促进术后肠道功能恢复，改善患者术后营养状况。

Application of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation

Objective To explore the feasibility and safety of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation. Methods Sixty rectal cancer patients undergoing selective low anterior resection were randomized into the trial group （n=30） and the control group （n=30）. Patients in the trial group received clean liquid integral protein diet for 3 days before operation without mechanical bowel preparation. Patients in the control group received traditional diet and mechanical bowel preparation. The intraoperative and postoperative clinical data, the quality of bowel preparation, postoperative complications, and nutritional parameters were compared between the two groups. Results There were no significant differences in clinicopathological characteristics between the two groups before operation. The operative time, blood loss, quality of bowel preparation as well as postoperative hospital stay were not significantly different （all P〉0.05）. While the time to first flatus （2.53±0.91） d vs. （3.03±0.68） d] and semi-liquid diet intake （3.95±0.83） d vs. （4.52±1.14） d] were significantly shorter in the trial group as compared with the control group （all P〈0.05）. There were no death and no significant difference in postoperative complications 16.7%（5/30） vs. 20.0%（6/30）, P〉0.05]. The levels of postoperative total protein, albumin, and prealbumin decreased significantly.Meanwhile, the levels of postoperative albumin （36.2±2.5） g/L vs. （33.5±2.6） g/L, P〈0.01] and prealbumin （325.4±28.2） mg/L vs. （302.5±34.2） mg/L, P〈0.01] in the trial group were significantly higher than those in the control group. Conclusions Preoperative enteral nutrition can replace the mechanical bowel preparation with better efficacy, and improve the postoperative nutritional status without increasing surgical risk in rectal cancer patients undergoing radical operation.