延长针刺式空肠造口置管肠内营养在胃癌术后辅助化疗中应用

目的 探讨延长针刺式空肠造口置管肠内营养在进展期胃癌术后辅助化疗中应用的可行性及其临床疗效。方法 将72例进展期胃癌术后辅助化疗患者随机分成A、B两组,每组36例;两组病例均于术中放置针刺式空肠造口管,A组延长空肠造口管留置时间至6个化疗疗程结束,每个化疗疗程经空肠造口管给予肠内营养液瑞能,每天1500ml,共7天,B组则于化疗前拔除空肠造口管,每个化疗疗程给予等热量普通饮食;观察A组延长空肠造口管留置及肠内营养并发症的发生率,比较两组化疗期间呕吐发生率及平均每日摄入量,比较两组化疗前后体重、血红蛋白、血清白蛋白、前白蛋白、转铁蛋白及血清白介素-2、NK细胞活性、T淋巴细胞亚群（CD^3＋、CD^4＋、CD^8＋）比例的变化情况。结果 A组延长空肠造口管留置及肠内营养无严重并发症发生;化疗期间A组呕吐发生率显著少于B组,平均每日摄入量显著多于B组;A组化疗前后体重、血红蛋白、血清白蛋白、前白蛋白、转铁蛋白、IL-2、NK细胞活性、CD3＋、CD4＋、CD8＋比例变化显著少于B组（P〈0.001）。结论 进展期胃癌术后辅助化疗期间延长针刺式空肠造口置管肠内营养是安全可行的,并具有减轻化疗呕吐,提高患者摄入量等优点,可以减少化疗药物对患者营养及免疫状况的影响,提高患者术后辅助化疗的耐受性及治疗效果。

Indewelling tube of prolonged needle puncture jejunostomy as enteral nutrition used in postoperative adjuvant chemotherapy of advanced gastric cancer

Objective To study the feasibility and clinical effects on indewelling tube of prolonged needle puncture jejunostomy as enteral nutrition used in postoperative adjuvant chemotherapy of advanced gastric cancer. Methods From January 2004 to December 2005,72 cases with advanced gastric cancer received radical gastrectomy and postoperative adjuvant chemotherapy were randomly divided into groupA(n=36) and groupB(n=36). Jejunal feeding tube was placed in all cases during operation.1500 ml/per day enteral nutrition solution was given for 7 days in one course,and the jejunal feeding tube was kept until the end of 6 chemotherapeutic course in group A. In the group B,jejunal feeding tube was removed before the chemotherapy and common diet of equivalen-caloric was given in every chemotherapeutic course.The gastrointestinal reactions were carefully observed and a series of parameters including body weight, hemoglobin(Hb),albumin(Alb),prealbumin(preAlb), transferring(TRF),serum level of IL-2,NK cells activities and T- lymphocyte subtypes were compared between 2 groups before and after chemotherapy. Results No severe complications were found in group A.The incidences of vomiting of group A was significantly lower than that group B.The average intake of group A was significantly lower than that group B.The mean every day intake of group A was significantly less than that group B.In the changes of body weight, Hb,Alb,preAlb,TRF,IL-2,NK cells activities,T-lymphocyte subtypes,the group A was significantly less than that group B before and after chemotherapy. Conclusion Indewelling tube of prolonged needle puncture jejunostomy as enteral nutrition is a safe and feasible method for patients of advanced gastric cancer of postoperative adjuvant chemotherapy.It can reduce the incidences of vomiting during chemotherapy period and improve patient's intake. This method also can improve patient's nutriture and immunologic function.