Wheble George A C, Benson Ruth A, Khan Omar A
Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):709-12. doi: 10.1093/icvts/ivs221. Epub 2012 Jun 29.
A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether, in patients undergoing an oesophagectomy for cancer, immediate postoperative enteral feeding (via percutaneous jejunostomy or nasojejunostomy) provides better patient outcomes as compared to waiting until oral feeding can be instituted. Four randomized controlled trials represented the best evidence to answer the clinical question. The first study randomized 25 patients into enteral feeding via jejunostomy (n = 13) versus a routine diet without jejunostomy (n = 12). The authors found no statistical difference in outcomes including length of stay, anastomotic complications and mortality. They did not report any catheter-related complications. A second study included patients undergoing an oesophagectomy or a pancreatodudenectomy, randomized to immediate postoperative jejunostomy feeding (n = 13) or remaining unfed for 6 days (n = 15). They reported one incident of detachment of the catheter from the abdominal wall. They also noted a statistically significant decrease in vital capacity and FEV1 in enterally fed patients. There was no difference in length of stay or anastomotic complications. They concluded that there was no indication for routine use of immediate postoperative enteral feeding in those patients without significant preoperative malnutrition. A third report randomized their post-oesophagectomy patients into enteral feeding via jejunostomy (n = 20) versus crystalloid only (n = 20). The also found no difference in length of stay, anastomotic leak rate or mortality. One catheter was removed due to concerns over respiratory function. They also concluded that there was no measurable benefit in early enteral feeding. The last of these 4 studies randomized patients into naso-duodenal feeding (n = 71) and jejunostomy feeding groups (n = 79). As in previous trials, they found no statistically significant difference between length of stay or anastomotic leak rates. Mortality was higher in the jejunostomy group, although the team did not attribute the deaths to the catheter. They found both methods equally effective in providing postoperative nutrition. In summary, all the trials concluded that routine postoperative enteral nutrition was feasible, but there was no evidence suggesting that it conferred any clinical benefits.
一篇外科领域的最佳证据主题文章是根据结构化方案撰写的。所探讨的问题是，对于因癌症接受食管切除术的患者，术后立即进行肠内喂养（通过经皮空肠造口术或鼻空肠造口术）与等待至可开始口服喂养相比，是否能为患者带来更好的预后。四项随机对照试验构成了回答该临床问题的最佳证据。第一项研究将25例患者随机分为经空肠造口进行肠内喂养组（n = 13）和不进行空肠造口的常规饮食组（n = 12）。作者发现，在住院时间、吻合口并发症和死亡率等预后指标上没有统计学差异。他们未报告任何与导管相关的并发症。第二项研究纳入了接受食管切除术或胰十二指肠切除术患者，随机分为术后立即进行空肠造口喂养组（n = 13）或6天不进食组（n = 15）。他们报告了1例导管从腹壁脱落事件。他们还指出，肠内喂养患者的肺活量和第一秒用力呼气量有统计学意义的下降。住院时间或吻合口并发症方面无差异。他们得出结论，对于那些术前无明显营养不良的患者，没有常规术后立即进行肠内喂养的指征。第三份报告将食管切除术后患者随机分为经空肠造口进行肠内喂养组（n = 20）和仅给予晶体液组（n = 20）。他们同样发现住院时间、吻合口漏率或死亡率无差异。因担心呼吸功能，拔除了1根导管。他们也得出结论，早期肠内喂养没有可衡量的益处。这4项研究中的最后一项将患者随机分为鼻十二指肠喂养组（n = 71）和空肠造口喂养组（n = 79）。与之前的试验一样，他们发现住院时间或吻合口漏率之间没有统计学显著差异。空肠造口组的死亡率较高，尽管该团队未将死亡归因于导管。他们发现两种方法在提供术后营养方面同样有效。总之，所有试验均得出结论，常规术后肠内营养是可行的，但没有证据表明其能带来任何临床益处。
