术前营养支持对慢性放射性肠炎并肠梗阻患者手术治疗效果的影响

目的探讨术前营养支持对放射性肠炎合并肠梗阻患者手术治疗效果的影响。方法回顾性分析因放射性肠炎合并肠梗阻而进行病变肠管切除手术的158例患者的临床资料。130例（82．3％）患者接受术前营养支持，其中行全胃肠外营养60例，完全肠内营养28例，肠内与肠外联合营养支持42例。分析术前营养支持对患者营养指标、手术方式、术后并发症及术后住院时间的影响。结果接受术前营养支持的130例患者血清白蛋白、前白蛋白和转铁蛋白等营养指标明显改善（均P〈0．05），但体质量指数和血红蛋白变化不明显（均P〉O．05）。与未接受营养支持者相比，术前行营养支持者肠造口率明显降低31．5％（41／130）比53．6％（15／28），P=O．027]。术后感染并发症发生率明显降低13．8％（18／130）比32．1％（9／28），P=O．019]，术后住院时间显著缩短（14．10±7．3）d比（18．8±15．8）d，P=-O．013]。在接受术前营养支持的130例患者中，能耐受或部分耐受肠内营养者，其肠造口率和感染性并发症发生率分别为28．6％（20／70）和7．1％（5／70）。术后住院时间为（15．5±9．6）d，明显优于全胃肠外营养者48．3％（29／60），P=O．020；21．7％（13／60），P=O．017；（21．7±19．0）d，P=O．025]。结论术前营养支持可有效降低放射性肠炎合并梗阻的手术治疗患者的肠造口率和术后感染性并发症发生率，缩短术后住院时间。如果可以耐受，应尽量选择肠内营养进行营养支持。

Influence of preoperative nutritional support on surgical outcomes of chronic radiation enteritis patients complicated with intestinal obstruction

Objective To investigate the effect of preoperative nutritional support in the management of patients with chronic radiation enteritis （CRE） with intestinal obstruction undergoing resectional surgery. Methods Clinical data of 158 CRE patients undergoing diseased bowel resection from 2001 to 2011 were analyzed retrospectively. A total of 130 patients received preoperative nutritional support, including 28 patients with enteral nutrition support, 60 patients with total parenteral nutrition support, and 42 patients with combined nutritional support. The nutritional parameters, procedures, operation-related complications, and postoperative hospital stay were recorded. Results After aggressive nutritional support in 130 patients, patients nutritional index, such as serum prealbumin, transferrin, serum albumin improved significantly preoperatively, while the change of body mass index and hemoglobin was not significant. Compared to those without preoperative nutritional support, those who received preoperative nutritional support had lower stoma rate（31.5% vs. 53.6%, P=0.027）, less postoperative infection rate（13.8% vs. 32.1%, P=0.019）, shorter postoperative hospital stay （14.1：t：7.3） d vs. （18.8±15.8） d, P=0.013 ）. Enteral nutrition group had less postoperative infection rate （7.1% vs. 21.7%, P=0.017）, lower stoma rate （28.6% vs. 48.3%, P=0.02）, and shorter postoperative hospital stay E（15.5±9.6） d vs.（21.7±19.0） d, P=0.025） as compared to total parenteral nutrition group. Conclusions Preoperative nutritional support can decrease the stoma rate, postoperative infection rate, and shorten hospital stay in CRE patients complicated with intestinal obstruction. If tolerated, enteral nutrition support should be chosen.