Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
J Gastric Cancer. 2011 Jun;11(2):101-8. doi: 10.5230/jgc.2011.11.2.101. Epub 2011 Jun 30.
Despite the compelling scientific and clinical data supporting the use of early oral nutrition after major gastrointestinal surgery, traditional bowel rest and intravenous nutrition for several postoperative days is still being used widely after gastric cancer surgery.
A phase II study was carried out to evaluate the feasibility and safety of postoperative early oral intake (water intake on postoperative days (POD) 1-2, and soft diet on POD 3) after a gastrectomy. The primary outcome was morbidity within 30 postoperative days, which was targeted at <25% based on pilot study data.
The study subjects were 90 males and 42 females with a mean age 61.5 years. One hundred and four (79%) and 28 (21%) patients underwent a distal and total gastrectomy, respectively. The postoperative morbidity rate was within the targeted range (15.2%, 95% CI, 10.0~22.3%), and there was no hospital mortality. Of the 132 patients, 117 (89%) successfully completed a postoperative early oral intake regimen without deviation; deviation in 10 (8%) due to gastrointestinal symptoms and in five (4%) due to the management of postoperative complications. The mean times to water intake and a soft diet were 1.0±0.2 and 3.2±0.7 days, respectively, and the mean hospital stay was 10.0±6.1 days.
Postoperative early oral intake after a gastrectomy is feasible and safe, and can be adopted as a standard perioperative care after a gastrectomy. Nevertheless, further clinical trials will be needed to evaluate the benefits of early oral nutrition after upper gastrointestinal surgery.
尽管有大量支持胃肠道手术后早期口服营养的有力科学和临床数据，但在胃癌手术后，仍广泛采用传统的肠道休息和静脉营养数天。
进行了一项 II 期研究，以评估胃切除术后早期口服摄入（术后第 1-2 天饮水，第 3 天软食）的可行性和安全性。主要结局是术后 30 天内的发病率，根据初步研究数据，目标为<25%。
研究对象为 90 名男性和 42 名女性，平均年龄为 61.5 岁。104 例（79%）和 28 例（21%）患者分别行远端胃切除术和全胃切除术。术后发病率在目标范围内（15.2%，95%CI：10.0~22.3%），无院内死亡。在 132 例患者中，117 例（89%）成功完成术后早期口服摄入方案，无偏差；10 例（8%）因胃肠道症状出现偏差，5 例（4%）因术后并发症管理出现偏差。开始饮水和软食的平均时间分别为 1.0±0.2 天和 3.2±0.7 天，平均住院时间为 10.0±6.1 天。
胃切除术后早期口服摄入是可行和安全的，可以作为胃切除术后的标准围手术期护理。然而，仍需要进一步的临床试验来评估上消化道手术后早期口服营养的益处。
