恶性肿瘤患者PD术后早期肠内联合肠外营养支持的临床研究外科学专业论文.docxVIP

恶性肿瘤患者 PD 术后早期肠内联合肠外营养支持的 临床研究 中文摘要 目的:探讨早期肠内联合肠外营养在恶性肿瘤患者胰十二指肠切除术后支持治 疗中的作用和地位。 方法:54 例胰十二指肠切除术后恶性肿瘤患者分入早期肠内营养联合肠外营养 组(EEN+PN) 或完全肠外(TPN) 营养组, 两组采用等热量、等氮量方案,比较两 组患者的营养状况、术后排气时间、术后住院时间和费用、术后并发症、营养 相关并发症。 结果:两种营养方式均能改善病人的营养状况。EEN+PN 组与 TPN 组相比:总并发 症发生率分别为 14.8％(4／27)与 33.3％(9／27),组间比较存在显著性差异； 术后排气时间分别为(3.9±1.2)d 与(4.5±3.1)d、住院时间(12.3±4.3)d 与(15. 2±5.1)d 及费用(31358±3114)元与(44650±11977)元,组间比较均存在显著性 差异。而两组患者术后胰瘘、胆瘘、切口感染、胃排空障碍等并发症、营养相 关并发症无显著性差异。 结论:早期肠内营养联合肠外营养可以降低术后并发症的发生率和住院期间费 用,在恶性肿瘤患者PD术后的营养支持值得推荐。 关键词:胰十二指肠切除术 肠内营养联合肠外营养 完全肠外营养 Clinical research of the combination of enteral and parenteral nutrition support in malignant patents in the early of PD postoperative ABSTRACT Object:To determine the effeets of total parenteral nutrition(TPN)and early enteral nutrition(EEN)on bioehemieal and clinical outcomes in cancer patients who underwent pancreaticoduodenectomy. Methods: fifty-seven patients who underwent pancreaticoduodenectomy were enrolled in this study. They were divided into the EEN+PN group and the TPN group. The program of isonitrogenous and isocaloric intake was taken in each group. The biochemical and clinical parameters were recorded and analyzed between the two groups. Results: Significant differences were found in total complications and hospital cost. The incidence rate of complications was higher in TPN group(33.3％) than EEN+PN group(14.8 ％ ) ； The hospital cost was higher in TPN group than in EEN+PN goup(44650 ± 11977)Yuan vs.(31358 ± 3114)Yuan. postoperative hospital stay and stimulating gut motion was longer in TPN group than in EEN+PN goup(15. 2±5. 1)d vs.(12.3 ± 4.3)d and(4.5 ± 3.1)d vs.(3.9 ± 1.2)d No significant differences were found in mortality,anastomotic leakage,hemorrhage, delayed gastric emptying, nutritional status between EEN+ PN group and TPN group. Conclusions:EEN +PN support can reduce the complications and hospital cost of cancer patients undergoing pancreatoduodenectomy. EEN+PN should be recommended as