中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (04): 337-339.

• 论著 • 上一篇    下一篇

输入袢空肠两点造口双向置管在胃癌毕Ⅱ式吻合术后早期及化疗期间肠内营养中的应用

宋洪江，魏玉哲，王 铁，薛英威   

  1. 哈尔滨医科大学附属肿瘤医院胃肠外科，黑龙江哈尔滨150081
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-04-03 发布日期:2009-04-03

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-04-03 Published:2009-04-03

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摘要：

目的 探讨胃癌毕Ⅱ式吻合+肠间吻合术后，经输入袢两点造口双向置管早期和化疗期间肠内营养支持的可行性、安全性和应用价值。方法 回顾性分析哈尔滨医科大学附属肿瘤医院2007年3月至2008年2月收治的62例行胃癌毕Ⅱ式吻合+肠间吻合术病人，实验组28例术中行输入袢两点造口双向置管，对照组34例术中经鼻咽置入胃管和空肠营养管。术后48h内开始行肠内营养支持。实验组化疗病人化疗期间经空肠造口营养管给予肠内营养支持。观察病人术后早期肠内营养支持期间不良反应、并发症及营养状况等，术后化疗病人观察营养和免疫指标等。结果 对照组排痰不利和睡眠不佳的发生率显著高于实验组，差异有统计学意义（P<0.05）。对照组并发症发生率高于实验组，但差异无统计学意义（P>0.05）。经过7d的肠内营养，实验组前白蛋白水平显著高于对照组，白细胞水平显著低于对照组，差异有统计学意义（t=2.347, P<0.05; t=2.870, P<0.01）。术后化疗期间，实验组病人的营养状态和免疫指标显著好于对照组（P<0.05）。结论 在胃癌毕Ⅱ式吻合+肠间吻合术后经输入袢两点造口双向置管行早期和化疗期间肠内营养支持是可行的、安全的，有利于病人术后早期恢复。为病人术后营养支持提供了一条重要的通道，值得临床大力推广。

关键词: 胃癌；毕Ⅱ式吻合；空肠造口术, 肠内营养, 辅助化疗

Abstract:

Role of “two-point” stoma and pacing tubes bilateral through afferent loop of patients with Billroth Ⅱ and Braun anastomosis during post operation and chemotherapy SONG Hong-jiang, WEI Yu-zhe, WANG Tie, et al. Department of Stomach Intestine Surgery, Tumor Hospital of Harbin Medical University, Harbin 150081, China Corresponding author: XUE Ying-wei, E-mail: XYW801@sina.com Abstract Objective To study the feasibility, safety and clinical effects of “two-point” stoma and pacing tubes bilateral through afferent loop of Billroth Ⅱ anastomosis in the early postoperative enteral nutrition and adjuvant chemotherapy for patients of gastric cancer. Methods 62 patients with gastric cancer underwent Billroth Ⅱ and Braun anastomosis were randomLy divided into experimental group (jejunostomy group, n=28) and control group (through nose group, n=34). All of the patients received EN 1d after surgery and continue at least 7d. experimental group received enteral nutrition through the tube during chemotherapy, the adverse effect, nutritional status and gastrointestinal comp lications were carefully observed during early postoperative enteral nutrition. A series of parameters were measured post chemotherapy. Results In early postoperative enteral nutrition, the incidence rate of disadvantage spit sputum and dyssomnia of experimental group were significantly lower than control group (P<0.05).The incidences of complication in experimental group was higher than that of in control group, but there was no statistical significance (P>0.05). After treatment for 7 days postoperation, the ratios of prealbumin were significantly increased in experimental group (t=2.347, P<0.05), and the level of WBC in experimental group was lower than control group (t=2.870, P<0.01). In post-chemotherapy, the nutritional status and immune state of experimental group were better than control group (P<0.05). Conclusion It is safe and feasible to enteral nutrition supported by “two-point” stoma and pacing tubes bilateral through afferent loop of patients with Billroth Ⅱ and Braun anastomosis. The method gives one more nutritional way for patients after operation.

Key words: gastric cancer, Billroth Ⅱ, jejunostomy, enteral nutrition, adjuvant chemotherapy