目的:明确术后早期肠内营养(EN)对腹腔镜胃癌根治术后康复和炎症反应的影响,以期为此类病人术后康复治疗提供参考.方法:纳入分析2020年1月至2022年12月在蚌埠医学院第一附属医院胃肠外科接受腹腔镜辅助胃癌根治术的病人.依据术后营养治疗的方式不同,将病人分为观察组(术后早期EN组)和对照组(肠外营养组),比较两组病人术后康复、腹腔引流量和引流液炎症介质水平等指标.结果:共计纳入81例病人,其中观察组41例,对照组40例.观察组病人术后首次排气时间(t=3.806;P<0.001)、恢复饮食日(t=5.510;P<0.001)以及术后住院日(t=2.401;P=0.019)均短于对照组病人.观察组病人术后5 d外周血白蛋白(t=14.040;P<0.001)和前白蛋白(t=9.832;P<0.001)水平显著高于对照组,但血红蛋白水平比较未见显著差异(t=1.477;P=0.144).观察组病人术后5 d外周血CRP水平(t=7.758;P<0.001)和术后SIRS发生率[(12.2%,5/41)vs(32.5%,13/40),x2=4.830;P=0.028)]均显著低于对照组病人.观察组病人术后5 d平均引流量(t=6.858;P<0.001)、拔管时间(t=5.016;P<0.001),以及术后 5d 引流液中 TNF-α(t=4.993;P<0.001)和 IL-6(t=20.640;P<0.001)水平均显著低于对照组病人.结论:术后早期EN可加速腹腔镜胃癌根治术后康复过程,改善术后营养状况和炎症反应.
Objective:To investigate the effect of early postoperative enteral nutrition(EN)on postoperative rehabilitation and inflammation after laparoscopic radical gastrectomy for gastric cancer,in order to provide reference for postoperative rehabilitation of such patients.Methods:Patients who received laparoscopic assisted radical gastrectomy in Department of Gastrointestinal Surgery of The First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2022 were included in the analysis.According to the different ways of postoperative nutritional treatment,patients were divided into the observation group(early postoperative EN group)and the control group(parenteral nutrition group),and indexes such as postoperative rehabilitation,abdominal drainage flow and the level of inflammatory mediators in drainage fluid were compared between the two groups.Results:A total of 81 patients were included,including 41 in the observation group and 40 in the control group.Interval of the first postoperative exhaust(t=3.806;P<0.001)and resuming diet day(t=5.510;P<0.001),and length of postoperative hospital stay(t=2.401;P=0.019)in the observation group were shorter than those in the control group.Levels of peripheral blood albumin(t=14.040;P<0.001)and prealbumin(t=9.832;P<0.001)of the observation group at postoperative day(POD)5 were significantly higher than those of the control group,but there was no significant difference in hemoglobin level(t=1.477;P=0.144).The level of CRP in peripheral blood of the observation group at POD 5(t=7.758;P<0.001)and the incidence of postoperative SIRS[(12.2%,5/41)vs(32.5%,13/40),x2=4.830;P=0.028)]were significantly lower than those in the control group.The average drainage volume(t=6.858;P<0.001),drainage removal time(t=5.016;P<0.001),and TNF-α level(t=4.993;P<0.001)and IL-6 level(t=20.640;P<0.001)in postoperative drainage at POD 5 were significantly lower in the observation group than those in the control group.Conclusion:Early postoperative EN could accelerate the rehabilitation process after laparoscopic radical gastrectomy,improve postoperative nutritional status,and reduce abdominal inflammation.