腹腔镜结直肠癌根治术后两种营养支持途径的疗效对比

摘要

Objective To compare the clinical efficacy and safety between enteral and parenteral nutritional support for colorectal cancer patients after undergoing laparoscopic radical resection.Methods Clinical data of 78 colorectal cancer patients undergoing laparoscopic radical resection in Department of General Surgery of Luoding People's Hospital between May 2014 and June 2016 were retrospectively analyzed.All patients were assigned into the enteral(EN) and parenteral nutritional(PN) support groups.The anthropometry and nutritional parameters,nutritional complications and medical expense before and 8 d after surgery were statistically compared between two groups.Results No statistical significance was identified in the preoperative nutritional parameters between two groups.The anthropometry parameters,hemoglobin,transferrin and digestive tract complications did not significantly differ between two groups at postoperative 8 d (all P<0.05).In the EN group,the pre-albumin and positive nitrogen balance were significantly higher (t=3.52,and 29.32,both P<0.001),whereas the incidence of carbohydrate metabolism disturbance and liver function damage was considerably lower than that in the PN group (both P<0.001).In the EN group,the recovery time of intestinal function was markedly earlier (P<0.001) and the nutritional support expense was considerably lower compared with that in the PN group (P<0.001).Conclusions EN support is superior to PN support in terms of maintaining negative nitrogen balance.Besides,EN support can decrease the risk of nutritional support-related complications,promote the recovery of intestinal function and reduce medical expense.EN support is an ideal option for postoperative recovery of colorectal cancer patients following laparoscopic radical resection.%目的 对比肠内营养与肠外营养对腹腔镜结直肠癌根治术后患者的营养状态、安全性和卫生经济学差异.方法 回顾分析2014年5月至2016年6月罗定市人民医院普外科行腹腔镜结直肠癌根治术的78例患者的病例资料,根据术后营养支持方式不同分为肠内营养组和肠外营养组,分别采用肠内和肠外营养支持,观察比较2组患者术前和术后8 d的人体测量学及营养学指标,营养相关并发症及费用.结果 术前2组各个营养学指标比较差异均无统计学意义,2组术后8 d各项人体测量学指标、血红蛋白、转铁蛋白以及消化道并发症比较差异均无统计学意义(P均>0.05).但肠内营养组的前白蛋白、正氮平衡高于肠外营养组(t=3.52和29.32,P均<0.001),糖代谢紊乱及肝功能损害等并发症发生率低于肠外营养组(P均<0.001),且肠内营养组患者肠功能恢复时间早于肠外营养组(P<0.001),营养支持相关花费低于肠外营养组(P<0.001).结论 在纠正负氮平衡方面肠内营养优于肠外营养,且肠内营养可减少营养支持相关并发症、促进肠功能恢复及降低费用,是腹腔镜结直肠癌根治术后患者快速康复的较好选择.