探讨术后早期肠内营养在肝细胞肝癌（肝癌）半肝切除患者中的应用价值。

本前瞻性研究对象为2010年10月至2012年9月在中山大学孙逸仙纪念医院肝胆胰外科行半肝切除术的67例肝癌患者。按照随机数字表法将患者分为肠内营养组和静脉营养组。肠内营养组32例，其中男17例，女15例；年龄（48±13）岁。静脉营养组35例，其中男22例，女13例；年龄（51±10）岁。所有患者均签署知情同意书，符合医学伦理学规定。两组患者均行标准解剖性半肝切除术，术后24 h拔除胃管，并根据具体病情进行护肝、补充人血白蛋白等常规处理。肠内营养组患者术后24 h开始给予安素营养液口服，维持至术后7 d。静脉营养组患者术后24 h内即开始给予静脉营养，维持7 d。观察两组患者围手术期丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、白蛋白（ALB）的变化，了解术后人血白蛋白应用情况、胃肠道功能恢复时间和胃肠道不良反应发生情况，统计住院时间和住院费用。两组患者计量资料的比较采用t检验或Wilcoxon秩和检验。

肠内营养组术前ALT（33±17）U/L，AST（35±19）U/L，ALB（36±1）g/L；静脉营养组术前ALT（34±14）U/L，AST（32±18）U/L，ALB（37±2）g/L，两组比较差异无统计学意义（t=0.264，0.664，1.618；P>0.05）。肠内营养组术后3 d的ALT、AST、ALB分别为（153±57）U/L、（108±46）U/L、（32±4）g/L，静脉营养组分别为（149±62）U/L、（104±45）U/L、（31±5）g/L；肠内营养组术后7 d的ALT、AST、ALB分别为（63±38）U/L、（65±44）U/L、（37±3）g/L，静脉营养组分别为（68±32）U/L、（61±39）U/L、（35±5）g/L；两组术后3 d和7 d的ALT、AST、ALB比较差异无统计学意义（t=0.274，0.360，0.898和-0.584，0.394，2.004；P>0.05）。肠内营养组术后静脉补充人血白蛋白总量为（70±25）g，静脉营养组为（90±35）g，肠内营养组人血白蛋白应用总量明显少于静脉营养组（t=-2.708，P<0.05）。肠内营养组术后胃肠道功能恢复时间为（46±13）h，静脉营养组为（66±15）h，肠内营养组术后胃肠道功能恢复时间明显短于静脉营养组（t=-5.807，P<0.05）。肠内营养组患者发生腹胀、腹泻3例，静脉营养组发生腹胀、腹泻2例。肠内营养组术后住院时间为（18±12）d，静脉营养组为（20±14）d，差异无统计学意义（t=-0.625，P>0.05）。肠内营养组和静脉营养组的总住院费用中位数分别为5.3（4.5~7.2）、5.9（5.1~7.9）万元，肠内营养组明显少于静脉营养组（Z=-2.34，P<0.05）。

早期肠内营养有利于肝癌半肝切除术后患者的胃肠道功能恢复，同时降低了住院费用。

To investigate the application value of early-stage enteral nutritional support in patients with hepatocellular carcinoma (HCC) after hemihepatectomy.

Sixty-seven HCC patients who underwent hemihepatectomy from October 2010 to December 2012 in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled in this prospective study. The patients were randomly divided into two groups using random digit table: the early enteral nutrition (EEN) group [n=32, 17 males, 15 females, mean age of (48±13) years old] and the parenteral nutrition (PN) group [n=35, 22 males, 13 females, mean age of (51±10) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Patients in both groups received standard anatomical hemihepatectomy and gastric tubes were withdrawn 24 h after operation. Routine treatments such as liver protection drugs, human albumin and so on were given to the patients according to the specific condition. Patients in EEN group were given Ensure nutrient solution orally from 24 h till 7 d after operation. Patients in PN group were given intravenous nutrition from 24 h till 7 d after operation. The changes of perioperative levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) of patients in two groups were observed. The application of human albumin, the length of gastrointestinal function recovery and adverse reactions of gastrointestine after operation were observed and the length of hospital stay and hospitalization cost were calculated. The measurement data between two groups was compared using t test or Wilcoxon rank sum test.

In EEN group, the preoperative level of ALT was (33±17)U/L, AST was (35±19)U/L, ALB was (36±1)g/L. In PN group, the preoperative level of ALT was (34±14)U/L, AST was (32±18)U/L, ALB was (37±2)g/L. There was no significant difference between two groups (t=0.264, 0.664, 1.618; P>0.05). In EEN group, the levels of ALT, AST, ALB on the 3^rd day after operation were (153±57)U/L, (108±46)U/L, (32±4)g/L respectively. In PN group, the levels of ALT, AST, ALB on the 3^rd day after operation were (149±62)U/L, (104±45)U/L, (31±5)g/L respectively. In EEN group, the levels of ALT, AST, ALB on the 7^th day after operation were (63±38)U/L, (65±44)U/L, (37±3)g/L respectively. In PN group, the levels of ALT, AST, ALB on the 7^th day after operation were (68±32)U/L, (61±39)U/L, (35±5)g/L respectively. There was no significant difference in the levels of ALT, AST, ALB on the 3^rd day and the 7^th day after operation between two groups (t=0.274, 0.360, 0.898 and-0.584, 0.394, 2.004; P>0.05). The total volume of intravenous human albumin given to the patients after operation in EEN group was significantly less than that in PN group [(70±25)g vs. (90±35)g; t=-2.708, P<0.05]. The length of postoperative gastrointestinal function recovery in EEN group was significantly shorter than that in PN group [(46±13)h vs. (66±15)h; t=-5.807, P<0.05]. Three cases suffered abdominal distention, diarrhea in EEN group and 2 cases in PN group. The length of postoperative hospital stay was (18±12)d in EEN group and was (20±14)d in PN group, there was no significant difference between two groups (t=-0.625, P>0.05). The median of total hospitalization cost in EEN group was significantly less than that in PN group [53(45-72) thousand yuan vs. 59(51-79) thousand yuan; Z=-2.34, P<0.05].

Early-stage enteral nutritional support is useful for the recovery of gastrointestinal function of HCC patients after hemihepatectomy and it can also reduce the hospitalization cost.