Petrelli N J, Cheng C, Driscoll D, Rodriguez-Bigas M A
Division of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo, USA.
Ann Surg Oncol. 2001 Dec;8(10):796-800. doi: 10.1007/s10434-001-0796-8.
Previous studies have shown that early postoperative oral feeding is feasible. Traditionally patients were fed when flatus or defecation documented the return of bowel function. This study was undertaken to determine factors that may preclude early feeding.
One hundred four successive patients underwent colorectal surgery from October 1999 to January 2001. Eighty-nine patients started an oral diet either on postoperative day 1 or 2. Their clinical outcomes were recorded prospectively. Fifteen of the 104 patients were excluded for small-bowel resection (5 patients), perioperative complications (5 patients), prior radiation (3 patients), and small-bowel obstruction (2 patients). A failure in postoperative feeding consisted of nausea, vomiting, or readmission.
The mean age of our cohort was 65 years (range, 28-87 years). There were 45 male and 44 female patients. The mean postoperative hospital stay was 6 days (range, 3-13 days). The median American Society of Anesthesiology score was II (range, I-IV). The types of resection performed were right colectomy (27 patients), low anterior resection (26 patients), sigmoid resection (11 patients), abdominoperineal resection (8 patients), formation or closure of colostomy (7 patients), posterior pelvic exenteration (4 patients), total colectomy (3 patients), left colectomy (2 patients), and transverse colectomy (1 patient). Sixty-five patients (73%) tolerated early oral feeding. Of the 24 patients that did not, 16 had nausea or emesis, and 8 required readmission for postoperative complications (small-bowel obstruction [4 patients], wound dehiscence [1 patient], abdominal pain [1 patient], and anastomotic leak [2 patients]). Univariate analysis revealed that the use of volume expanders contributed to intolerance of early feeding. On multivariate analysis, blood loss during the operation was the only factor contributing to failure of early postoperative oral feeding.
Early oral feeding is safe and feasible for postcolectomy patients with a history of colorectal neoplasms.
既往研究表明，术后早期经口进食是可行的。传统上，当记录到胃肠功能恢复（有排气或排便）时才开始给患者喂食。本研究旨在确定可能妨碍早期进食的因素。
1999年10月至2001年1月，连续104例患者接受了结直肠手术。89例患者在术后第1天或第2天开始经口饮食。前瞻性记录他们的临床结局。104例患者中有15例因小肠切除术（5例）、围手术期并发症（5例）、既往放疗史（3例）和小肠梗阻（2例）被排除。术后进食失败包括恶心、呕吐或再次入院。
我们队列的平均年龄为65岁（范围28 - 87岁）。有45例男性和44例女性患者。术后平均住院时间为6天（范围3 - 13天）。美国麻醉医师协会评分中位数为II（范围I - IV）。所进行的切除类型包括右半结肠切除术（27例）、低位前切除术（26例）、乙状结肠切除术（11例）、腹会阴联合切除术（8例）、结肠造口术的形成或关闭（7例）、后盆腔脏器清除术（4例）、全结肠切除术（3例）、左半结肠切除术（2例）和横结肠切除术（1例）。65例患者（73%）耐受早期经口进食。在24例不耐受的患者中，16例有恶心或呕吐，8例因术后并发症（小肠梗阻[4例]、伤口裂开[1例]、腹痛[1例]和吻合口漏[2例]）需要再次入院。单因素分析显示，使用容量扩张剂导致早期进食不耐受。多因素分析显示，手术期间的失血量是导致术后早期经口进食失败的唯一因素。
对于有结直肠肿瘤病史的结肠切除术后患者，早期经口进食是安全可行的。
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