探讨腹腔镜肝癌切除术后早期肠内营养的临床应用价值。

本前瞻性研究对象为2013年11月至2014年6月在中山大学孙逸仙纪念医院行腹腔镜肝癌切除术的49例患者。采用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25例，男20例，女5例；平均年龄（49±17）岁。静脉营养组24例，男18例，女6例；年龄（51±14）岁。所有患者均签署知情同意书，符合医学伦理学规定。肠内营养组术后24 h开始给予安素营养液口服，维持至术后7 d。静脉营养组术后24 h内即开始给予静脉营养，维持至术后7 d。比较两组患者术后补充人血白蛋白总量、术后胃肠道功能恢复时间、术后住院时间和住院费用等。观察营养支持相关并发症发生情况。两组资料比较采用t检验或Wilcoxon秩和检验。

肠内营养组术后静脉补充人血白蛋白总量为（40±11）g，明显少于静脉营养组的（45±10）g（t=-16.089，P<0.05）。肠内营养组术后胃肠功能恢复时间为（25±8）h，明显短于静脉营养组的（43±11）h（t=-36.928，P<0.05）。肠内营养组术后住院时间为（8±2）d，明显短于静脉营养组的（10±3）d （t=-12.025，P<0.05）。肠内营养组的总住院费用为4.5(3.7～6.1)万元，明显少于静脉营养组的4.9(4.2～6.7)万元（Z=-18.495，P<0.05）。肠内营养组发生腹胀、腹泻5例，静脉营养组发生腹胀、腹泻8例，调整剂量或输液速度后缓解。

腹腔镜肝癌切除术后早期肠内营养有助于患者胃肠功能恢复，可有效减轻患者经济负担，总体疗效优于静脉营养。

To investigate the clinical application value of early enteral nutrition after laparoscopic hepatectomy for hepatocellular carcinoma (HCC).

A total of 49 patients with HCC undergoing laparoscopic hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between November 2013 and June 2014 were included in this prospective study. These patients were divided into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Twenty-five patients were divided into the enteral nutrition group, among them, 20 were males and 5 were females with the average age of (49±17) years old. Twenty-four patients were divided into the parenteral nutrition group, among them, 18 were males and 6 were females with the average age of (51±14) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the enteral nutrition group were given Ensure nutrient solution orally 24 h after operation for 7 d and the patients in the parenteral nutrition group were given parenteral nutrition 24 h after operation for 7 d. The total human albumin supplemented volume, recover time of gastrointestinal function, length of hospital stay after operation and hospitalization expenses of the two groups were compared. The nutritional support associated complications were observed. The data of the two groups were compared using t test or Wilcoxon rank-sum test.

The total human albumin supplemented volume after operation of the enteral nutrition group was (40±11) g, which was significantly lower than (45±10) g of the parenteral nutrition group(t=-16.089, P<0.05). The recovery time of gastrointestinal function after operation of the enteral nutrition group was (25±8) h, which was significantly shorter than (43±11) h of the parenteral nutrition group (t=-36.928, P<0.05). The length of hospital stay after hepatectomy of the enteral nutrition group was (8±2) d, which was significantly lower than (10±3) d of parenteral nutrition group (t=-12.025, P<0.05). The total hospitalization expenses of the enteral nutrition group were RMB 45,000 (37,000-61,000) yuan, which were significantly lower than RMB 49,000 (42,000-67,000) yuan of the parenteral nutrition group (Z=-18.495, P<0.05). Five patients in the enteral nutrition group and 8 patients in the parenteral nutrition group developed abdominal distention and diarrhea, which were alleviated by adjusting doses or infusion speed.

Early enteral nutrition after laparoscopic hepatectomy for HCC is beneficial to the postoperative recovery of gastrointestinal function and may effectively reduce the financial burden of patients. Moreover, its overall curative effect is better than that of parenteral nutrition.