Xin-Hua Zhu, Ya-Fu Wu, Yu-Dong Qiu, Chun-Ping Jiang, Yi-Tao Ding, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu Province, China.
World J Gastroenterol. 2013 Sep 21;19(35):5889-96. doi: 10.3748/wjg.v19.i35.5889.
To investigate the effect of early enteral nutrition (EEN) combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy (PD).
From January 2006, all patients were given EEN combined with parenteral nutrition (PN) (EEN/PN group, n = 107), while patients prior to this date were given total parenteral nutrition (TPN) (TPN group, n = 67). Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery. The assessment of clinical outcome was based on postoperative complications. Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge. Readmission within 30 d after discharge was also recorded.
Compared with the TPN group, a significant decrease in prealbumin (PAB) (P = 0.023) was seen in the EEN/PN group. Total bilirubin (TB), direct bilirubin (DB) and lactate dehydrogenase (LDH) were significantly decreased on day 6 in the EEN/PN group (P = 0.006, 0.004 and 0.032, respectively). The rate of grade I complications, grade II complications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased (P = 0.036, 0.028 and 0.021, respectively), and no hospital mortality was observed in our study. Compared with the TPN group (58.2%), the rate of infectious complications in the EEN/PN group (39.3%) was significantly decreased (P = 0.042). Eleven cases of delayed gastric emptying were noted in the TPN group, and 6 cases in the EEN/PN group. The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group (P = 0.031 and P = 0.040, respectively).
Early enteral combined with PN can greatly improve liver function, reduce infectious complications and delayed gastric emptying, and shorten postoperative hospital stay in patients undergoing PD.
探讨胰十二指肠切除术后早期肠内营养（EEN）联合肠外营养（PN）支持的效果。
自 2006 年 1 月起，所有患者均给予 EEN 联合 PN（EEN/PN 组，n=107），而在此之前的患者则给予全肠外营养（TPN）（TPN 组，n=67）。术前 1 天和术后 6 天采集静脉血样进行营养评估和肝功能检查。根据术后并发症评估临床结局。对感染和非感染性并发症进行 30 天的出院后随访。还记录了出院后 30 天内的再入院情况。
与 TPN 组相比，EEN/PN 组的前白蛋白（PAB）显著降低（P=0.023）。EEN/PN 组第 6 天总胆红素（TB）、直接胆红素（DB）和乳酸脱氢酶（LDH）明显下降（P=0.006、0.004 和 0.032）。EEN/PN 组的 I 级并发症、II 级并发症发生率和术后住院时间明显缩短（P=0.036、0.028 和 0.021），本研究中无院内死亡。与 TPN 组（58.2%）相比，EEN/PN 组的感染并发症发生率（39.3%）显著降低（P=0.042）。TPN 组有 11 例发生胃排空延迟，EEN/PN 组有 6 例。EEN/PN 组胃排空延迟和高血糖的发生率显著降低（P=0.031 和 P=0.040）。
胰十二指肠切除术后早期肠内联合 PN 可明显改善肝功能，降低感染并发症和胃排空延迟的发生率，缩短术后住院时间。
