老年结直肠癌腹腔镜根治术后早期肠内营养的快速康复价值分析

摘要

Objective To understand the actual clinical significance of early enteral nutritional supply in elderly patients with colorectal cancer after laparoscopic surgery. Methods A total of 62 elderly patients with colorectal cancer accepted laparoscopic radical surgery were alloca-ted in this study,the external nutritional supply(EN)of 32 cases in study group had been given through the nasogastric tube in the second day af-ter operation. Patients in control group(parenteral nutrition,PN,30 cases)were routinely given with mixed venous nutritional supply containing amino acids,fat emulsion,glucose and electrolytes through the central venous catherter within 2 ~ 7 d after operation. The postoperative nutritional index,fasting blood sugar,complications,first exhaust,defecation and length of hospital stay were compared between these two groups. Results The blood levels of prealbumin and albumin in patients of PN group were decreased more significantly in 3rd and 7th days after the operation. The difference in amplitude of decrease between these 2 groups in the same period was statistically significant( P < 0. 05). There was no serious gas-trointestinal complications such as anastomotic leakage,intestinal obstruction or perioperative mortality occurred. The rate of postoperative compli-cations in EN group was 12. 5% ,that in PN group was 20. 0% ,and their difference was statistically significant( P < 0. 05). The duration for postoperative first exhaust,defecation and hospital stay in patients of PN group was longer than that of patients in EN group( P < 0. 05). Conclu-sion The early application of EN in elderly patients with colorectal cancer after laparoscopic surgery is safe. It can significantly promote the recov-ery of intestinal function and reduce the malnutrition - related and other complications,in order to achieve fast track to goals for rehabilitation.%目的：了解老年结直肠癌腹腔镜手术后患者早期应用肠内营养（EN）的实际临床价值。方法老年结直肠癌腹腔镜根治性手术62例，肠内营养组（EN 组，32例）经鼻胃管术后第2天起给予要素饮食，肠外营养组（PN 组，30例）经中心静脉术后第2~7天内常规给予葡萄糖、氨基酸、脂肪乳和电解质的全合一静脉营养液。分析两组术后营养指标、空腹血糖、并发症发生率及首次排气、排便及住院时间的差异。结果术后第3天和第7天 PN 组的前白蛋白和白蛋白下降程度更为显著，与同期 EN 组相比下降幅度有统计学差异（ P <0.05）；两组均无吻合口瘘、肠梗阻等消化道并发症及围手术期死亡，EN 组的术后并发症率为12.5%，PN 组为20.0%，两组比较差异有统计学意义（ P <0.05）；PN组的术后首次排气、排便以及住院时间均较比 EN 组长（ P <0.05）。结论老年结直肠癌腹腔镜手术后早期应用 EN是安全的，可明显促进肠功能恢复，减少营养不良相关合并症和并发症，达到快速康复目标。