关键词: 克罗恩病, 全肠外营养, 肠内营养, 术后并发症, 预康复

Abstract: Comparative analysis of preoperative total parenteral nutrition and enteral plus parenteral nutrition affecting the outcome of surgical treatment of Crohn's disease        SUN Zhen-ya*, SONG Tian-run, CHEN Yu-sheng, et al. *Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002,China
Corresponding author: ZHU Wei-ming, E-mail:yfy135@njucm.edu.cn
Abstract    Objective    To assess the impact of preoperative nutritional prehabilitation with total parenteral nutrition (TPN) versus enteral combined parenteral nutrition (EN+PN) on the outcomes of surgical patients with Crohn's disease (CD) complicated with intestinal obstruction or intestinal fistula. Methods    The clinical data of 200 patients who underwent surgery after nutritional prehabilitation with TPN or EN+PN for CD combined with intestinal obstruction or intestinal fistula at the Inflammatory Bowel Disease Treatment Centre of General Surgery Department, Affiliated Hospital of Medical School, Nanjing University, from 2012-12-01 to 2021-12-01 were retrospectively analyzed. The patients were divided into the TPN group (137 cases) and, the EN+PN group (63 cases) according to the different ways of nutritional prehabilitation used. The propensity score matching (PSM) method was used to compare the effects of nutritional treatment and the incidence of complications at 30 d postoperatively between the TPN group and the EN+PN group. Results    Before PSM, patients in the TPN and EN+PN groups had higher albumin levels and hemoglobin levels after nutritional pre-rehabilitation therapy compared with those before nutritional pre-rehabilitation therapy, and the albumin level in the EN+PN group was higher than that in the TPN group (35.7 ± 4.4 g/L vs. 33.5 ± 5.4 g/L, t=-2.79,P=0.003); C-reactive protein in the EN+PN group was lower than that in the TPN group, but the difference was not statistically significant, 6.3 (1.1,20.5)mg/Lvs.9.9 (2.3,30.0)mg/L,Z=-1.27,P=0.201; hemoglobin levels were higher in the EN+PN group than in the TPN group,112.5 ± 15.5 g/L vs. 105.3 ± 18.8 g/L, t=-2.6,P=0.005. After PSM with hemoglobin and albumin as matching variables in a 1:2 ratio, there were 96 cases in the TPN group and 60 cases in the EN+PN group, respectively, and there was no statistically significant difference in the comparison of the albumin level and hemoglobin level between the two groups (both P > 0.05). After surgical treatment, the incidence of enterostomy (50.0% vs. 30.0%, χ2=6.1, P=0.022), superficial wound infection (27.1% vs. 10.0%, χ2=6.6, P=0.018), ileus (58.3% vs. 33.3%,χ2=9.2, P=0.004), and overall postoperative complications (70.8% vs. 41.7%, χ2=13.1, P=0.001) were higher in the TPN group compared with the EN+PN group. In addition, the TPN group had a longer hospital stay than the EN+PN group,11.0 (7.0,16.0)d vs.8.0 (6.7,11.0)d, Z=-2.4, P=0.013. Conclusions    Both TPN and EN+PN can be used for nutritional prehabilitation and both can achieve satisfactory results, but nutritional prehabilitation with EN+PN may be better in terms of nutritional treatment effects and surgical outcomes, which deserves further research to validate.

Key words: Crohn’s disease, total parenteral nutrition, enteral nutrition, postoperative complications, prehabilitation