胰十二指肠切除术后早期全肠外营养与肠外联合肠内营养疗效比较

摘要

目的:研究经全肠外营养(TPN)及肠外联合肠内营养(EPN)对胰十二指肠切除术后早期的临床疗效.方法:选取弋矶山医院2013年10月~2016年9月收治的胰十二指肠肿瘤患者并行胰十二指肠切除术85例.按随机表法分为TPN组42例和EPN组43例.对比分析两组术后营养指标、肝功能指标、术后恢复情况及住院费用.结果:在术后恢复情况方面,EPN组肛门排气时间及术后进流质时间比TPN组短,差异有统计学意义(P<0.05),EPN组住院时间低于TPN组,但差异无统计学意义(P>0.05);两组术后并发症及住院费用方面比较差异无统计学意义(P>0.05);两组患者术后营养指标及肝功能指标较术前比较差异均有统计学意义(P<0.05);EPN组术后3 d白蛋白(ALB)水平与TPN组比较差异有统计学意义(P<0.05),余营养指标组间比较差异无统计学意义(P>0.05);两组术后谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBIL)比较差异有统计学意义(P<0.05),术后3 d直接胆红素(DBIL)比较差异有统计学意义(P<0.05).结论:肠外联合肠内营养方式相对于全肠外营养能有效改善预后,更适合患者胃肠道且安全经济,值得在临床上进一步研究.%Objective:To investigate the clinical effect of total parenteral nutrition (TPN) and parenteral nutrition combined with enteral nutrition (EPN) in the early stage of pancreatodeodenectomy.Methods: Eighty-five cases of pancreatic and duodenal neoplasms undergone pancreatodeodenectomy in our hospital between October 2013 and September 2016 were included, and allocated to TPN group(n=42) and EPN group(n=43) by random digital table.Then the two groups were compared concerning the postoperative nutritional indexes, liver functions, recovery status and hospital costs.Results: In postoperative recovery, EPN group had earlier anal exhaust and liquid intake than the TPN group (P<0.05).Although EPN group had lower hospital costs than the TPN group, yet the difference was not significant (P>0.05).The two groups were not significantly different in postoperative complications and hospital costs (P>0.05), yet were different in postoperative nutritional parameters and liver function indexes(P<0.05).The serum albumin (ALB) levels measured after three days of operation were statistically different between groups(P<0.05), and the remaining indicators remained no difference(P>0.05).The difference was significant regarding postoperative aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL)levels as well as direct bilirubin (DBIL) levels measured three days after surgery between groups(P<0.05).Conclusion: EPN is worthy of wider clinical recommendation, for it can better improve the prognosis, and be safer and more economical than TPN.