胃癌患者远端胃大部切除联合Roux-en-Y吻合术后营养支持治疗的临床研究

摘要

Objective To investigate the method of nutritional support after distal subtotal gastrectomy combined with Roux-en-Y anastomosis in patients with gastric cancer and analyze its clinical effect.Methods The data of 79 patients with gastric cancer treated by distal subtotal gastrectomy combined with Roux-en-Y anastomosis from September 2016 to May 2018 in Houma People's Hospital were retrospectively analyzed .According to the nutritional support methods , patients were divided into enteral group (42 cases, receiving enteral nutritional support ) and parenteral group ( 37 cases, receiving parenteral nutritional support ).The postoperative recovery time , the changes of body nutrition indexes , humoral immunity indexes and the incidences of postoperative complications were compared between the two groups . Results The first exhaust, first defecation, first ambulation and hospitalization time in enteral group were shorter than those in parenteral group (P<0.05).The levels of hemoglobin (HGB), serum prealbumin (PAB), plasma albumin (ALB), total protein (TP), immunoglobulin (IgA, IgG, IgM), complement 3 (C3), complement 4 (C4) were increased in enteral group 7 days after operation (P<0.05), which were unchanged in parenteral group ( P>0.05);and the levels of the above indexes in enteral group were higher than those in parenteral group 7 days after operation ( P<0.05 ).The total incidence of postoperative complications in enteral group was significantly lower than that in parenteral group 7 days after treatment (P<0.05).Conclusions Compared with parenteral nutrition support , enteral nutrition support after distal gastrectomy combined with Roux-en-Y anastomosis can quicken recovery , improve nutritional and humoral immune indexes, and reduce the incidence of complications in patients with gastric cancer .%目的 探讨在胃癌患者远端胃大部切除联合Roux-en-Y吻合术后营养支持治疗的方法,并分析其临床作用.方法 回顾性分析侯马市人民医院2016年9月至2018年5月收治的实施远端胃大部分切除联合Roux-en-Y吻合术治疗的79例胃癌患者的临床资料,根据营养支持治疗方式分为肠内组(42例,接受肠内营养支持)与肠外组(37例,接受肠外营养支持).比较两组术后恢复时间,术后当天和术后7 d机体营养指标、体液免疫指标变化,术后并发症发生率.结果 肠内组术后首次排气、首次排便、首次下床活动时间和住院时间均短于肠外组(P均<0.05).术后7 d,肠内组血红蛋白(HGB)、血清前白蛋白(PAB)、血浆白蛋白(ALB)、总蛋白(TP)、免疫球蛋白(IgA、IgG、IgM)、补体3(C3)、补体4(C4)水平均升高(P均<0.05),肠外组基本无变化(P>0.05);且术后7 d肠内组上述指标均高于肠外组(P<0.05).术后7 d,肠内组内总并发症发生率低于肠外组(P均<0.05).结论 对于胃癌患者,远端胃大部分切除联合Roux-en-Y吻合术后给予肠内营养支持较肠外营养支持者能够加快患者恢复,改善机体营养指标和体液免疫指标,降低并发症发生率.