术后早期经口进食对结直肠癌术后体液免疫功能的影响

目的探讨术后12h内经口进食对结直肠癌患者术后临床结局及体液免疫的影响。方法前瞻性人组中山大学附属第一医院2008年5—12月间拟行限期根治性手术的70例结直肠癌患者，按随机数字表法分为早期进食组（术后12h内开始进食）和传统进食组（术后肛门排气后开始进食），每组35例。比较两组患者术后临床指标及体液免疫指标。结果62例患者完成试验，其中早期进食组32例，传统进食组30例。早期进食组较传统进食组患者术后排气时间（21）d比（4±2）d，P〈0．01]、排粪时间（3．8±1．6）d比（6．4±2．5）d，P〈0．01]、半流饮食时间（4±2）d比（8．2±2．2）d，P〈0．01]和术后住院时间（6±1）d比（11．7±3．8）d，P〈0．01]均明显缩短。术后两组患者各项体液免疫指标均明显下降，之后逐渐回升，但早期进食组恢复速度快于传统饮食组，至术后第3天，早期进食组较传统进食组患者球蛋白（24．1±2．4）g／L比（22．1±3．3）g／L，P〈0．05]、免疫球蛋白G（10．8±2．4）g／L比（8．7±2．1）g／L，P〈0．01）和补体C4（0．24±0．09）g／L比（0．17±0．05）g／L，P〈0．05]水平明显增高。结论术后12h内经口进食应用于限期结直肠癌手术患者安全有效，有助于加快术后肠道功能恢复，缩短术后住院时间，并促进术后体液免疫功能的恢复。

Effect of postoperative early enteral nutrition on the recovery of humoral immune function in patients with colorectal carcinoma undergoing elective resection

Objective To investigate the effect of postoperative early oral feeding on humoral immune function and clinical outcome in colorectal cancer patients. Methods Seventy patients with colorectal carcinoma requiring elective colorectal resection were prospectively enrolled and randomized into two groups： early oral feeding group （n=35） and conventional oral feeding group （n=35）. The patients in early oral feeding group were started on oral feeding within 12 hours after operation, while patients in conventional group were started on oral feeding after the postoperative first passage of flatus. Postoperative parameters of clinic and humeral immune function were compared between two groups. Results Sixty-two patients eventually completed the study, including 32 cases in early oral feeding group and 30 cases in conventional oral feeding group. The average time to first passage of flatus （2±1） d vs. （4±2） d, P〈0.01], the first passage of stool （3.8±1.6） d vs. （6.4±2.5） d, P〈0.01], resumption of regular diet （4±2） d vs. （8.2±2.2） d, P〈0.01] and the postoperative hospital stay （6±1） d vs. （11.7±3.8） d, P〈0.01 ] were significantly shorter in early oral feeding group as compared to conventional oral feeding group. Significantly faster recovery of postoperative humoral immunity was found. Plasma levels of globulin （24.1±2.4） g/L vs. （22.1±3.3） g/L, P〈0.05 ], immunoglobulin G （ 10.8±2.4） g/L vs. （8.7±2.1） g/L, P〈0.01 ] and complement 4 （0.24±0.09） g/L vs. （0.17±0.05） g/L, P〈0.05 l on postoperative day 3 were higher in early oral feeding group as compared to conventional oral feeding group. Conclusion Application of postoperative early oral feeding in patients undergoing elective colorectal resection is safe and effective, which can lead to faster recovery of postoperative humoral immune function and bowel function, and shorter postoperative hospital stay.