切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (03): 165 -168. doi: 10.3877/cma.j.issn.2095-3232.2015.03.008

所属专题: 文献

临床研究

腹腔镜肝癌切除术后早期肠内营养的临床应用价值
姚金科1, 陈捷2, 商昌珍2,(), 张晓1, 黄延年1, 陈亚进2   
  1. 1. 511300 广州,中山大学孙逸仙纪念医院增城院区普通外科
    2. 510120 广州,中山大学孙逸仙纪念医院肝胆胰外科
  • 收稿日期:2015-03-12 出版日期:2015-06-10
  • 通信作者: 商昌珍
  • 基金资助:
    国家自然科学基金(81372562); 广东省科技计划项目(2012B031800378); 高校基本科研业务费中山大学青年教师培育项目(14ykpy21)

Clinical application value of early enteral nutrition after laparoscopic hepatectomy for hepatocellular carcinoma

Jinke Yao1, Jie Chen2, Changzhen Shang2,(), Xiao Zhang1, Yannian Huang1, Yajin Chen2   

  1. 1. Department of General Surgery, Zengcheng Branch, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 511300, China
    2. Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
  • Received:2015-03-12 Published:2015-06-10
  • Corresponding author: Changzhen Shang
  • About author:
    Corresponding author: Shang Changzhen, Email:
目的

探讨腹腔镜肝癌切除术后早期肠内营养的临床应用价值。

方法

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。

结果

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。

结论

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。

Objective

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

Methods

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.

Results

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.

Conclusions

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.

表1 肠内营养组与静脉营养组腹腔镜肝癌肝切除患者围手术期一般资料比较
表2 肠内营养组与静脉营养组腹腔镜肝癌肝切除患者术后临床指标比较
[1]
牛坚,汪海军,邵华,等.腹腔镜肝癌切除术对术后机体康复和免疫的影响研究[J/CD].中华腔镜外科杂志:电子版,2014, 7(3): 32-35.
[2]
李权林,李敬东,徐威,等.肝癌肝切除术后持续低蛋白血症的相关因素分析[J].中华消化外科杂志,2012,11(2): 151-154.
[3]
陈颖君,范英华,乔羽,等.肝癌患者肝切除前后口服肠内营养混悬液的效果观察[J].中华护理杂志,2012, 47(5): 399-401.
[4]
商昌珍,张磊,余达成,等.术后早期肠内营养在肝细胞肝癌半肝切除患者中的应用价值[J/CD].中华肝脏外科手术学电子杂志,2013, 2(5): 298-301.
[5]
黄静,武杰.肝癌切除术后早期肠内营养支持40例[J].中国现代普通外科进展,2012, 15(9): 716-718.
[6]
杨帆,蒙谦,周明忠.肠内营养对肝癌术后小肠糖异生影响的研究[J].华中科技大学学报:医学版,2008, 37(6): 773-776.
[7]
吴健雄,王黎明,荣维淇,等.肝癌合并肝硬化患者术后不同剂型肠内营养的临床效果[J].中华临床营养杂志,2013, 21(6): 345-350.
[8]
苏永辉,侯冰宗,贾英斌,等.肝癌肝切除术后早期免疫增强型肠内营养对患者结局的影响[J].中华临床营养杂志,2012, 20(5): 302-305.
[9]
章静,涂楚云.肝癌术后早期肠内营养的观察与护理[J].广东医学,2011, 32(16): 2099-2100.
[10]
黄秀琴.肠内营养在腹腔镜结直肠癌根治术后的应用及护理[J].右江民族医学院学报,2010, 32(6):977-978.
[11]
刘文居,池小丹,魏丞,等.胃癌腹腔镜术后早期肠内营养的效果评价[J].福建医药杂志,2014, 36(2): 13-16.
[12]
胡细玲,凌聪,周雪玲.谷氨酰胺强化肠内营养在腹腔镜胃癌根治术后早期的应用[J].全科护理,2012, 10(20): 1881-1882.
[13]
吴恺明,马晋平,王亮.早期肠内营养在腹腔镜结直肠癌根治术后应用的疗效观察[J/CD].消化肿瘤杂志:电子版,2012,4(3): 180-182.
[14]
赵明利,薛琪,李雅男,等.腹腔镜结肠癌术后早期口服肠内营养的临床观察[J].中华胃肠外科杂志,2013,16(11): 1041-1044.
[15]
王强,曹杰,陈熙文.早期肠内营养在腹腔镜辅助式结直肠癌术后应用的临床研究[J].岭南现代临床外科,2011,11(3): 168-170.
[16]
徐国辉,吕赛平,解长佶,等.老年肝癌患者肝癌切除术后早期肠内营养支持治疗的临床价值[J].实用癌症杂志,2013, 28(6): 722-724.
[17]
薛玉珠.早期肠内营养对肝癌介入术后机体营养状况及肠功能的影响[J].中国美容医学,2012, 21(18): 492-493.
[1] 王莹莹, 刘莉, 吕瑞兆, 柳洁, 白晓明, 井郁陌. 下腔静脉变异度为指导的围手术期容量管理在腹腔镜肝切除术中的临床应用[J]. 中华普通外科学文献(电子版), 2022, 16(03): 194-198.
[2] 顾竹劼, 胡双双, 师小伟, 马钰, 陆敏敏, 汪建胜. 老年肝癌合并肝硬化患者围手术期不同液体管理在腹腔镜肝切除术中的对比研究[J]. 中华普通外科学文献(电子版), 2022, 16(03): 199-204.
[3] 周保富, 吴乐乐, 李永红, 胡世超. 肝切除术中不同断肝方式治疗多病灶原发性肝癌的临床效果研究[J]. 中华普通外科学文献(电子版), 2022, 16(03): 205-209.
[4] 刘贤, 兰春斌, 胥彬, 徐竹林, 宋正宇. 肝切除术围手术期症状性静脉血栓栓塞症风险评估模型的建立及验证[J]. 中华普外科手术学杂志(电子版), 2022, 16(03): 319-322.
[5] 张安清, 东爱华, 李红霞, 李爱华. 三种肝血流阻断技术在腹腔镜下肝切除术中的对比研究[J]. 中华普外科手术学杂志(电子版), 2022, 16(03): 323-326.
[6] 阙清扬, 余炯杰, 凌孙彬, 徐骁. 免疫治疗在肝癌肝移植降期治疗中的应用及前景[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 221-224.
[7] 陈泰安, 熊永福, 徐建, 李强, 杨刚, 李敬东. 复杂肝癌腹腔镜肝切除的应用及挑战[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 239-243.
[8] 周陈杰, 王杰钦, 张健民, 冯磊, 傅超毅, 廖晖, 徐小平, 高毅. 浅谈腹腔镜解剖性肝切除手术入路和解剖标志[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 244-247.
[9] 苟晓雪, 王明达, 薛军, 史鸿云, 张新, 杨田. 立体定向放射治疗在肝细胞癌合并门静脉癌栓中的应用[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 248-251.
[10] 谢静, 毛先海, 杨建辉, 段小辉, 田朕安, 张雄, 高绪照. 再次肝切除与腹腔镜微波消融治疗复发性小肝癌临床疗效比较[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 258-262.
[11] 卢文峰, 付雍, 阎凯, 袁建勇, 陈佩钦, 张海斌. 术后预防性TACE对肝内胆管细胞癌患者预后的影响[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 268-272.
[12] 陈一帆, 王晨晨, 卢杏生. 肝内胆管导管内乳头状瘤恶变伴门静脉及胆道变异一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 299-303.
[13] 江哲龙, 魏志鸿, 杜俊杰, 江艺, 吕立志, 杨芳. FOXC2对肝癌肝移植患者预后的影响[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 309-314.
[14] 熊培尧, 唐雨豪, 杨子良, 朱应钦, 王骏成, 徐立. 小鼠VETC(+)肝癌模型构建及索拉非尼对VETC结构的影响[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 315-319.
[15] 江蜜, 柴楚星, 张树华, 唐勇, 胡青钢, 万赤丹, 熊俊. 微波消融联合手术切除治疗巨大肝血管瘤一例[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 320-322.
阅读次数
全文


摘要