Di Carlo V, Gianotti L, Balzano G, Zerbi A, Braga M
Department of Surgery, Scientific Institute S. Raffaele Hospital, Milan, Italy.
Dig Surg. 1999;16(4):320-6. doi: 10.1159/000018742.
According to international guidelines, artificial nutrition may be indicated after pancreaticoduodenectomy (PD). This clinical study was designed to evaluate whether the route of administration and the composition of the postoperative nutritional support could affect outcome.
One hundred patients who underwent PD for cancer of the pancreatic head were prospectively studied. Patients were randomized to receive a standard enteral formula (SEN; n = 35) or immunonutrition with an enteral formula enriched with arginine, omega-3 fatty acids, and RNA (IEN group; n = 33), or total parenteral nutrition (TPN; n = 32). Postoperative feeding was started within 12 h after surgery. The three regimens were isoenergetic and isonitrogenous. Tolerance of enteral feeding, rate and severity of postoperative complications, and length of hospital stay (LOS) were evaluated.
Full nutritional goal (25 kcal/kg) was achieved in 84% of enterally fed patients versus 96% in the parenteral group (p = NS). The rate of postoperative complications was lower in the IEN group (33%) than in the SEN (40%) and TPN groups (59%). The severity of infectious complications (sepsis score) was lower in the IEN (5.5) than the SEN (7.9) and TPN groups (10.4; p < 0.05). LOS was shorter in the IEN than in the SEN and TPN groups (16.3 vs. 17.8 vs. 19.3 days, respectively; p < 0.05).
In patients undergoing PD the established nutritional goal can be obtained by enteral feeding. Immunonutrition seems to improve outcome.
根据国际指南，胰十二指肠切除术（PD）后可能需要进行人工营养支持。本临床研究旨在评估术后营养支持的给药途径和组成是否会影响治疗结果。
前瞻性研究了100例因胰头癌接受PD的患者。患者被随机分为接受标准肠内营养配方（SEN；n = 35）或富含精氨酸、ω-3脂肪酸和RNA的肠内免疫营养配方（IEN组；n = 33），或全肠外营养（TPN；n = 32）。术后喂养在手术后12小时内开始。三种方案的能量和氮含量相同。评估肠内喂养的耐受性、术后并发症的发生率和严重程度以及住院时间（LOS）。
84%的肠内喂养患者实现了完全营养目标（25 kcal/kg），而肠外营养组为96%（p =无显著性差异）。IEN组术后并发症发生率（33%）低于SEN组（40%）和TPN组（59%）。IEN组感染性并发症的严重程度（脓毒症评分）低于SEN组（7.9）和TPN组（10.4；p < 0.05）。IEN组的住院时间短于SEN组和TPN组（分别为16.3天、17.8天和19.3天；p < 0.05）。
在接受PD的患者中，通过肠内喂养可以实现既定的营养目标。免疫营养似乎能改善治疗结果。
