Comparison of Two Clinical Nutrition Supports in Patients with Esophageal Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

陳宇 , 陳保富 , 張波 , 葉中瑞 , 林江 , 葉敏華 , 馬德華

浙江省臺州醫院（浙江臨海 317000）;

Corresponding?author：

Keywords：

食管癌術后; 腸內營養; 腸外營養

DOI：

10.7507/1007-4848.20160201

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目的探討兩種不同途徑的營養方式對食管癌患者術后恢復的影響。方法選取浙江省臺州醫院心胸外科2007～2011年63例食管癌患者術后的不同營養支持，分為腸內營養（enteral nutrition，EN）組（33例）和腸外營養（parenteral nutrition，PN）組（30例），比較兩組的術后胃腸功能恢復、營養指標、并發癥情況、住院費用、住院時間及肝功能等影響。結果 EN組與PN組的排氣時間[（42.30±6.70）h vs.（60.60±15.60）h，P＜0.01]、住院時間[（15.40±6.55）d vs.（21.00±10.57）d，P＜0.01]、住院費用[（4.49 ±1.28）萬元vs.（4.73 ±1.18）萬元，P＜0.01]差異均有統計學意義。兩組術后均無吻合口漏等嚴重并發癥，兩組術后白蛋白水平較術前有不同程度下降，術后肝功能PN組較EN組變化大，兩組差異有統計學意義（P＜0.01）。結論兩種營養方式均能改善患者的術后營養狀況，但腸內營養更符合生理特點、廉價，適應現代營養支持，較靜脈營養有優勢。

Citation： 陳宇, 陳保富, 張波, 葉中瑞, 林江, 葉敏華, 馬德華. Comparison of Two Clinical Nutrition Supports in Patients with Esophageal Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 841-843. doi: 10.7507/1007-4848.20160201 Copy

1.	Maturo G, Vespasiani G, Mohamed EI, et al. Evaluating body com-position of Italian prostate cancer patients without metastases. Acta Diabetol, 2003, 40(Suppl 1):S168-S170.
2.	Norman K, Pichard C, Lochs H, et al, Prognostic impact of disease-related malnutrition. Clin Nutr, 2008, 27(1):5-15.
3.	Takagi K, Yamamori H, Morishima Y, et al, Preoperative immuno-suppression:its relationship with high morbidity and mortality in patients receiving thoracic esophagectomy. Nutrition, 2001, 17(1):13-17.
4.	劉超群, 李欣, 浦江, 等.早期腸內營養對晚期食管癌患者的臨床應用評價.中國綜合臨床, 2013, 29(9):953-956.
5.	黎介壽.臨床營養支持的發展趨勢.腸外與腸內營養, 2010, 17(1):1-4.
6.	Pomposelli JJ, Flores E, Hirschberg Y, et al, Short-term TPN containing n-3 fatty acids ameliorate lactic acidosis induced by endotoxin in guinea pigs. Am J Clin Nutr, 1990, 52(3):548-552.
7.	Braga M, et al, Feeding the gut early after digestive surgery:results of a nine-year experience. Clin Nutr, 2002, 21(1):59-65.
8.	Heidegger CP, Romand JA, Treggiari MM, et al. Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med, 2007, 33(6):963-969.
9.	Aiko S, Yoshizumi Y, Sugiura Y, et al. Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today, 2001, 31(11):971-978.
10.	Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding:a systematic review and meta-analysis. J Gastrointest Surg, 2009, 13(3):569-575.
11.	康維明, 于健春, 馬志強, 等.胃腸道手術后規范化序貫腸內腸外營養支持療法與腸外營養支持的臨床隨機對照研究.中華臨床營養雜志, 2011, 19(3):148-153.
12.	趙桂彬, 曹守強, 張凱, 等.快速康復外科對食管癌手術患者胰島素抵抗指標的影響.中華臨床營養雜志, 2012, 20(2):78-83.
13.	趙桂彬, 曹守強, 張凱, 等.早期腸內營養對食管癌患者術后免疫功能和臨床結局的影響.中華胃腸外科雜志, 2014, 4:356-360.
14.	Wang D, Kong Y, Zhong B, et al. Fast-track surgery improves posto-perative recovery in patients with gastric cancer:a randomized comparison with conventional postoperative care. J Gastrointest Surg, 2010, 14(4):620-627.
15.	Wang LH, Fang F, Lu CM, et al. Safety of fast-track rehabilitation after gastrointestinal surgery:systematic review and meta-analysis. World J Gastroenterol, 2014, 20, 41:15423-15439.

1. Maturo G, Vespasiani G, Mohamed EI, et al. Evaluating body com-position of Italian prostate cancer patients without metastases. Acta Diabetol, 2003, 40(Suppl 1):S168-S170.
2. Norman K, Pichard C, Lochs H, et al, Prognostic impact of disease-related malnutrition. Clin Nutr, 2008, 27(1):5-15.
3. Takagi K, Yamamori H, Morishima Y, et al, Preoperative immuno-suppression:its relationship with high morbidity and mortality in patients receiving thoracic esophagectomy. Nutrition, 2001, 17(1):13-17.
4. 劉超群, 李欣, 浦江, 等.早期腸內營養對晚期食管癌患者的臨床應用評價.中國綜合臨床, 2013, 29(9):953-956.
5. 黎介壽.臨床營養支持的發展趨勢.腸外與腸內營養, 2010, 17(1):1-4.
6. Pomposelli JJ, Flores E, Hirschberg Y, et al, Short-term TPN containing n-3 fatty acids ameliorate lactic acidosis induced by endotoxin in guinea pigs. Am J Clin Nutr, 1990, 52(3):548-552.
7. Braga M, et al, Feeding the gut early after digestive surgery:results of a nine-year experience. Clin Nutr, 2002, 21(1):59-65.
8. Heidegger CP, Romand JA, Treggiari MM, et al. Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med, 2007, 33(6):963-969.
9. Aiko S, Yoshizumi Y, Sugiura Y, et al. Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today, 2001, 31(11):971-978.
10. Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding:a systematic review and meta-analysis. J Gastrointest Surg, 2009, 13(3):569-575.
11. 康維明, 于健春, 馬志強, 等.胃腸道手術后規范化序貫腸內腸外營養支持療法與腸外營養支持的臨床隨機對照研究.中華臨床營養雜志, 2011, 19(3):148-153.
12. 趙桂彬, 曹守強, 張凱, 等.快速康復外科對食管癌手術患者胰島素抵抗指標的影響.中華臨床營養雜志, 2012, 20(2):78-83.
13. 趙桂彬, 曹守強, 張凱, 等.早期腸內營養對食管癌患者術后免疫功能和臨床結局的影響.中華胃腸外科雜志, 2014, 4:356-360.
14. Wang D, Kong Y, Zhong B, et al. Fast-track surgery improves posto-perative recovery in patients with gastric cancer:a randomized comparison with conventional postoperative care. J Gastrointest Surg, 2010, 14(4):620-627.
15. Wang LH, Fang F, Lu CM, et al. Safety of fast-track rehabilitation after gastrointestinal surgery:systematic review and meta-analysis. World J Gastroenterol, 2014, 20, 41:15423-15439.

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