Aiko Satoshi, Yoshizumi Yutaka, Ishizuka Takamitsu, Horio Takuya, Sakano Takashi, Kumano Isao, Kanai Norishige, Maehara Tadaaki
Department of Surgery II, National Defense Medical College, Tokorozawa, Saitama, Japan.
Dis Esophagus. 2008;21(7):619-27. doi: 10.1111/j.1442-2050.2008.00827.x. Epub 2008 May 2.
We previously reported that provision of immediate enteral nutrition (EN) with a certain amount of omega (omega)-3 fatty acids (FAs) in patients after esophageal cancer surgery resulted in reduced platelet aggregation, coagulation activity, and cytokine production. We investigated whether EN using immuno-enhanced diet (IED) containing a large amount of omega-3 FAs as well as arginine and RNA affected the above-described responses. We also attempted to reveal whether arginine in the IED can potentially harm patients who undergo esophageal cancer surgery. Twenty-nine patients with esophageal cancer who underwent similar surgical procedures were selected. All patients received EN starting immediately after surgery. Fourteen patients received the formula with fewer omega-3 FAs, and fifteen patients received the IED. Administration of the IED tended to inhibit postoperative decrease in platelet count. Prothrombin activity and thrombin-antithrombin III complex levels were significantly reduced in the IED group. Plasma IL-8 levels were significantly lower (P < 0.05) in patients without the IED on the fifth postoperative day (POD). The proportion of T-cells was significantly higher (P < 0.05) in the IED group on PODs 1 and 7. Nitrate/nitrite levels did not differ significantly between the two groups. Early EN with an IED may enhance the inhibitory effects on postoperative platelet aggregation and hypercoagulation, and appeared to be advantageous to T-cell proliferation. These effects are expected to be beneficial in patients at risk of developing infectious complications. This study also showed that the IED could be safely used without any adverse effects for patients early after a radical surgery for the esophageal cancer.
我们之前报道过，食管癌手术后患者立即接受含有一定量ω-3脂肪酸（FAs）的肠内营养（EN）可降低血小板聚集、凝血活性和细胞因子生成。我们研究了使用含有大量ω-3 FAs以及精氨酸和RNA的免疫增强饮食（IED）进行肠内营养是否会影响上述反应。我们还试图揭示IED中的精氨酸是否可能对接受食管癌手术的患者造成潜在伤害。选取了29例接受类似手术的食管癌患者。所有患者术后立即开始接受肠内营养。14例患者接受ω-3 FAs含量较少的配方，15例患者接受IED。给予IED有抑制术后血小板计数下降的趋势。IED组的凝血酶原活性和凝血酶 - 抗凝血酶III复合物水平显著降低。术后第5天（POD），未接受IED的患者血浆IL - 8水平显著较低（P < 0.05）。在术后第1天和第7天，IED组的T细胞比例显著较高（P < 0.05）。两组间硝酸盐/亚硝酸盐水平无显著差异。早期使用IED进行肠内营养可能增强对术后血小板聚集和高凝状态的抑制作用，且似乎有利于T细胞增殖。这些作用预计对有发生感染性并发症风险的患者有益。本研究还表明，对于食管癌根治术后早期的患者，IED可安全使用且无任何不良反应。
