腹腔镜术后早期经口进食对结直肠癌患者功能状态和胃肠生存质量的影响

摘要

目的：探讨腹腔镜结直肠癌术后早期经口进食（EOF）对患者功能状态及胃肠生存质量的影响，阐明结直肠癌患者术后 EOF的可行性。方法：63例接受腹腔镜结直肠癌手术治疗的患者随机分为2组，其中31例采用 EOF （EOF组），术后第1天给予经口液体，如能耐受给予半流食或普食；32例采用传统经口进食（TOF组），胃肠功能恢复以后给予半流食或普食。所有患者术后第1天拔除胃肠减压管。采用自制 EOF量表、卡氏（Karnofsky）评分及胃肠道生存质量（GIQLI）评分量表对患者功能状态和胃肠生存质量进行评估。结果：EOF组患者全肠外营养（TPN）使用时间、术后住院费用和术后住院天数均低于 TOF组（P＜0.05）；术后首次排气时间和首次排便时间2组比较差异无统计学意义（P＞0.05）；EOF组患者腹胀发生率高于TOF组（P＜0.05），重置胃管、肺内感染、肠梗阻、菌群失调、吻合口瘘和切口感染等并发症2组间比较差异无统计学意义（P＞0.05）。2组患者术后第7天白蛋白与术前恢复程度比较差异有统计学意义（P＜0.05），术后第4和7天血清前白蛋白较术前恢复程度比较差异亦有统计学意义（P＜0.05）。术后第4天 EOF组患者卡氏评分高于TOF组（P＜0.05），GIQLI评分手术前后变化明显，EOF组患者术后饮食受限评分和 GIQLI总评分优于 TOF组（P＜0.05）。结论：腹腔镜结直肠癌手术患者术后 EOF可促进患者早日康复，降低住院风险，节省住院费用，对术后蛋白恢复起到积极作用，并且能够提高患者术后功能状态及胃肠生存质量。%Objective To investigate the influence of early oral feeding (EOF)after laparoscopic surgery in the function status and gastrointestinal living quality of the patients with colorectal cancer,and to clarify the feasibility of EOF after laparoscopic surgery.Methods Sixty-three patients underwent laparoscopic surgery of colorectal cancers participated in the trial.Of these,31 patients received EOF as EOF group,received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated;the other 32 patients received traditional oral feeding (TOF ) as TOF group who were fed with feeding only after the recovery of their postoperative gastrointestinal functions. The nasogastric tube was removed from all patients in both groups immediately after surgery.Self-designed EOF questionnaire data, Karnofsky Scores and Gastrointestinal Quality of Life Index (GIQLI)Scores were used to evaluate the functional status and gastrointestinal living guality of the patients. Results The using time of total parenteral nutrition (TPN),time of postoperative hospital stay,and costs after surgery in EOF group were lower than those in TOF group (P<0.05);but there were no significnat differences in the first passage of flatus and feces time between two groups (P<0.05),also there were no significant differences in the incidence of nasogastric tube reinsertion, pulmonary infection, intestinal obstruction, balance of intestinal bacteria,fistula,incision infection between two groups (P>0.05),and the incidence of abdominal distension was higher than that in TOF group (P<0.05);on postoperative day 7,the albumin recovered faster in EOF group (P<0.05),and on postoperative day 4 and 7,the pro-albumin also recovered faster in EOF group (P<0.05);the patients in EOF group had a higher Karnofsky score (P<0.05)and GIQLI score compared with the patients in TOF group (P<0.05 ). Conclusion EOF after laparoscopic surgery in the patients with colorectal cancers is beneficial for rehabilitation,and it can reduce the risk of hospitalization and saving its costs;it plays an active role in protein recovery,and improves the functional status and gastrointestinal living quality of the patients.