Oya Hisaharu, Koike Masahiko, Iwata Naoki, Kobayashi Daisuke, Torii Koji, Niwa Yukiko, Kanda Mitsuro, Tanaka Chie, Yamada Suguru, Fujii Tsutomu, Nakayama Goro, Sugimoto Hiroyuki, Nomoto Shuji, Fujiwara Michitaka, Kodera Yasuhiro
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, 466-8550, Japan.
World J Surg. 2015 May;39(5):1105-10. doi: 10.1007/s00268-015-2952-5.
Nutritional support influences the outcome of gastroenterological surgery, and enteral nutrition effectively mitigates postoperative complications in highly invasive surgery such as resection of esophageal cancer. However, feeding via jejunostomy can cause complications including mechanical obstruction, which could be life threatening. From 2009, we began enteral feeding via duodenostomy to reduce the likelihood of complications. In this study, we compared duodenostomy with the conventional jejunostomy feeding, mainly looking at the catheter-related complications.
The database records of 378 patients with esophageal cancer who underwent radical esophagectomy with retrosternal or posterior mediastinal gastric tube reconstruction in our department from January 1998 to December 2012 were examined. Of the 378 patients, 111 underwent feeding via duodenostomy (FD) and 267 underwent feeding via jejunostomy (FJ), and their records were reviewed for the following catheter-related complications: site infection, dislodgement, peritonitis, and mechanical obstruction.
Mechanical obstruction occurred in 12 patients in the FJ group but none in the FD group (4.5 % vs. 0 %, P = 0.023). Of the 12 cases, 7 (58.3 %) required surgery of which 2 had bowel resection due to strangulated mechanical obstruction. Catheter site infection was seen in 14 cases in the FJ group, of which 2 (14.2 %) had peritonitis following catheter dislocation, while only one case of site infection was seen in the FD group (5.2 % vs. 0.9 %, P = 0.078).
Feeding via duodenectomy could be the procedure of choice since neither mechanical obstruction nor relaparotomy was seen during enteral feeding through this technique.
营养支持会影响胃肠外科手术的预后，肠内营养能有效减轻诸如食管癌切除术等高侵袭性手术的术后并发症。然而，经空肠造口喂养可能引发包括机械性梗阻在内的并发症，这可能危及生命。自2009年起，我们开始经十二指肠造口进行肠内喂养以降低并发症的发生几率。在本研究中，我们比较了十二指肠造口喂养与传统空肠造口喂养，主要观察导管相关并发症。
查阅了1998年1月至2012年12月在我科接受经胸骨后或后纵隔胃管重建根治性食管癌切除术的378例食管癌患者的数据库记录。在这378例患者中，111例接受十二指肠造口喂养（FD），267例接受空肠造口喂养（FJ），并对他们的记录进行回顾以查找以下导管相关并发症：置管部位感染、导管移位、腹膜炎和机械性梗阻。
FJ组有12例发生机械性梗阻，而FD组无1例发生（4.5% 对0%，P = 0.023）。在这12例中，7例（58.3%）需要手术治疗，其中2例因绞窄性机械性梗阻行肠切除术。FJ组有14例发生导管置管部位感染，其中2例（14.2%）因导管移位导致腹膜炎，而FD组仅1例发生置管部位感染（5.2% 对0.9%，P = 0.078）。
经十二指肠造口喂养可能是首选方法，因为通过该技术进行肠内喂养期间未出现机械性梗阻或再次剖腹手术的情况。
