远端肠内营养有助于胰腺切除患者的血糖控制。
Distal Enteral Feeding Helps Blood Sugar Control in Pancreatectomized Patients.
作者信息
Wu Jin-Ming, Yang Ching-Yao, Kuo Ting-Chun, Lai Hong-Shiee, Chiang Pin-Yi, Hsieh Su-Hua, Tien Yu-Wen
机构信息
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, Roc.
Department of Nursing, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Roc.
出版信息
World J Surg. 2015 Nov;39(11):2771-5. doi: 10.1007/s00268-015-3157-7.
BACKGROUND
The change in the route of food passage after pancreaticoduodenectomy (PD) is quite similar to the change after gastric bypass surgery; both procedures bypass the duodenum and directly connect to the distal jejunum. Moreover, both procedures result in resolution of type 2 diabetes mellitus. Therefore, more distal enteral anastomosis after PD may further improve glycemic status.
METHODS
To test the effect of distal enteral feeding on glucose metabolism in patients after PD, we performed a meal test on 20 patients via a nasogastric tube [proximal feeding group (PFG)] on post-operative day 5 and then via an intra-operatively placed jejunostomy feeding tube [distal feeding group (DFG)] on post-operative day. Blood samples were assessed for hormones and glucose.
RESULTS
The AUC0-120 min levels of GLP-1, C-peptide, and insulin after distal feeding were significantly higher than after proximal feeding. The AUC0-120 min levels of glucose in the DFG were significantly lower than in the PFG.
CONCLUSIONS
More distal enteral feeding contributed to better glucose metabolism after PD.
背景
胰十二指肠切除术（PD）后食物通过途径的改变与胃旁路手术后的改变非常相似；这两种手术都绕过十二指肠并直接与空肠远端相连。此外，这两种手术都能使2型糖尿病得到缓解。因此，PD术后更低位的肠内吻合可能会进一步改善血糖状况。
方法
为了测试低位肠内喂养对PD术后患者葡萄糖代谢的影响，我们在术后第5天通过鼻胃管对20例患者进行了进餐测试[近端喂养组（PFG）]，然后在术后第 天通过术中放置的空肠造口喂养管进行测试[远端喂养组（DFG）]。采集血样检测激素和葡萄糖水平。
结果
远端喂养后GLP-1、C肽和胰岛素的AUC0-120分钟水平显著高于近端喂养后。DFG组的AUC0-120分钟血糖水平显著低于PFG组。
结论
更低位的肠内喂养有助于PD术后更好地进行葡萄糖代谢。
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