Zhao Guibin, Cao Shouqiang, Zhang Kai, Xin Yanzhong, Han Jingquan, Dong Qing, Cui Jian
Department of Thoracic Surgery, The Fourth Hospital of Harbin Medical University, Harbin 150001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Apr;17(4):356-60.
To evaluate the effect of early enteral nutrition(EEN) on immune response and clinical outcomes after esophageal cancer operation.
Sixty patients with esophageal cancer undergoing radical operation between March 2010 and July 2011 were randomly divided into two groups using envelope method: EEN group(n=30, administration of water and enteral nutrition early after operation) and TPN group(n=30, administration of total parenteral nutrition). Two groups both received 7-day nutrition support. Immune indexes(CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) and serum nutritional indexes(albumin, pre-albumin, transferrin) were measured before operation and 1-, 3-, and 7-day after operation. The time to first flatus, length of postoperative hospital stay, total hospitalization cost, and postoperative complication were recorded.
As compared to TPN group, the time to first flatus was significantly shorter in EEN group[(66.5±7.3) h vs. (75.1±6.8) h, P<0.01], as was hospital stay[(7.8±1.1) d vs. (9.3±1.3) d, P<0.01]. Total hospitalization cost[(36 210±3810) yuan vs. (39 731±4013) yuan, P<0.01] was lower in EEN group as compared to TPN group. There was no significant difference in postoperative complication rate between the two groups[13.3%(3/30) vs. 20.0%(6/30), P>0.05]. The levels of CD3(+), CD4(+), CD4(+)/CD8(+), albumin, prealbumin and transferrin were significantly higher in EEN group as compared to TPN group on postoperative day 3 and 7(all P<0.05), while CD8(+) was significantly lower in EEN group(P<0.05).
EEN can promote early recovery of gastrointestinal function, improve nutritional and immune function, and therefore lead to fast postoperative recovery in esophageal cancer patients.
评估早期肠内营养（EEN）对食管癌手术后免疫反应及临床结局的影响。
采用信封法将2010年3月至2011年7月期间行根治性手术的60例食管癌患者随机分为两组：EEN组（n = 30，术后早期给予水和肠内营养）和TPN组（n = 30，给予全胃肠外营养）。两组均接受7天的营养支持。于术前及术后1天、3天和7天测量免疫指标（CD3(+)、CD4(+)、CD8(+)、CD4(+)/CD8(+)）和血清营养指标（白蛋白、前白蛋白、转铁蛋白）。记录首次排气时间、术后住院时间、总住院费用及术后并发症情况。
与TPN组相比，EEN组首次排气时间显著缩短[（66.5±7.3）小时对（75.1±6.8）小时，P<0.01]，住院时间也显著缩短[（7.8±1.1）天对（9.3±1.3）天，P<0.01]。EEN组总住院费用[（36 210±3810）元对（39 731±4013）元，P<0.01]低于TPN组。两组术后并发症发生率无显著差异[13.3%（3/30）对20.0%（6/30），P>0.05]。术后第3天和第天，EEN组CD3(+)、CD4(+)、CD4(+)/CD8(+)、白蛋白、前白蛋白和转铁蛋白水平均显著高于TPN组（均P<0.05），而EEN组CD8(+)显著降低（P<0.05）。
EEN可促进食管癌患者胃肠功能早期恢复，改善营养和免疫功能，从而使患者术后快速康复。
