Abu-Hilal Mohammad, Hemandas Anil K, McPhail Mark, Jain Gaurav, Panagiotopoulou Ioanna, Scibelli Tina, Johnson Colin D, Pearce Neil W
Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital, Southampton, SO16 6YD, United Kingdom.
JOP. 2010 Jan 8;11(1):8-13.
Postoperative enteral nutrition is thought to reduce complications and speed recovery after pancreatic resection. There is little evidence on the best route for delivery of enteral nutrition. Currently we use percutaneous transperitoneal jejunostomy or percutaneous transperitoneal gastrojejunostomy, or the nasojejunal route to deliver enteral nutrition, according to surgeon preference.
To compare morbidity, efficiency, and safety of these three routes for enteral nutrition following pancreaticoduodenectomy.
Data were obtained from a prospectively maintained database, for all patients undergoing pancreatic resection between January 2007 and June 2008. One-hundred pancreatic resected patients underwent enteral nutrition: 93 had Whipple's operations and 7 had total pancreatectomies.
Enteral nutrition was delivered by agreed protocol, starting within 24 h of operation and increasing over 2-3 days to meet full nutritional requirement.
Delivery route of enteral nutrition was: percutaneous transperitoneal jejunostomy in 25 (25%), percutaneous transperitoneal gastrojejunostomy in 32 (32%) and nasojejunal in 43 (43%). The incidence of catheter-related complications was higher in percutaneous techniques: 24% in percutaneous transperitoneal jejunostomy and 34% in percutaneous transperitoneal gastrojejunostomy as compared to nasojejunal technique (12%). Median time to complete establishment of oral intake was 14, 14 and 10 days in percutaneous transperitoneal jejunostomy, percutaneous transperitoneal gastrojejunostomy, and nasojejunal groups, respectively. Nasojejunal tubes were removed at median 11 days (mean 11.5 days) compared to 5-6 weeks for percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy. Commonest catheter-related complication in the percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy was blockage (n=6; 10.5%), followed by pain after removal of feeding tube at 5-6 weeks (n=5; 8.8%), whereas in the nasojejunal group it was blockage (n=3; 7.0%), followed by displacement (n=2; 4.7%). Two patients died postoperatively in this cohort, however, there were no catheter-related mortalities.
Enteral nutrition following pancreatic resection can be delivered in different ways. Nasojejunal feeding was associated with fewest and less serious complications. On current evidence surgeon preference is a reasonable way to decide enteral nutrition but a randomized controlled trial is needed to address this issue.
术后肠内营养被认为可减少胰腺切除术后的并发症并加速康复。关于肠内营养的最佳输注途径，几乎没有证据。目前，我们根据外科医生的偏好，采用经皮经腹空肠造口术、经皮经腹胃空肠造口术或鼻空肠途径来提供肠内营养。
比较胰十二指肠切除术后这三种肠内营养途径的发病率、有效性和安全性。
数据来自一个前瞻性维护的数据库，涵盖了2007年1月至2008年6月期间所有接受胰腺切除术的患者。100例接受胰腺切除术的患者接受了肠内营养：93例行Whipple手术，7例行全胰切除术。
按照商定的方案提供肠内营养，在术后24小时内开始，并在2 - 3天内逐渐增加，以满足全部营养需求。
肠内营养的输注途径为：经皮经腹空肠造口术25例（25%），经皮经腹胃空肠造口术32例（32%），鼻空肠途径43例（43%）。经皮技术的导管相关并发症发生率较高：经皮经腹空肠造口术为24%，经皮经腹胃空肠造口术为34%，而鼻空肠技术为12%。经皮经腹空肠造口术组、经皮经腹胃空肠造口术组和鼻空肠组完全建立经口进食的中位时间分别为14天、14天和10天。鼻空肠管中位在11天（平均11.5天）拔除，而经皮经腹空肠造口术和经皮经腹胃空肠造口术为5 - 6周。经皮经腹空肠造口术和经皮经腹胃空肠造口术最常见的导管相关并发症是堵塞（n = 6；10.5%），其次是5 - 6周拔除喂养管后的疼痛（n = 5；8.8%），而鼻空肠组是堵塞（n = 3；7.0%），其次是移位（n = 2；4.7%）。该队列中有2例患者术后死亡，但没有导管相关死亡病例。
胰腺切除术后的肠内营养可以通过不同方式提供。鼻空肠喂养的并发症最少且较轻。根据目前的证据，外科医生的偏好是决定肠内营养的合理方式，但需要进行一项随机对照试验来解决这个问题。
