Shenoy Jayarama, Adapala Rajesh Kumar Reddy
Department of Surgery, Kasturba Medical College, Manipal University, Mangalore, India.
Indian J Surg. 2015 Dec;77(Suppl 2):275-82. doi: 10.1007/s12262-012-0795-y. Epub 2013 Jan 27.
Jejunostomy is usually indicated as an additional procedure during major surgery of upper digestive tract to administer enteral nutrition in post-operative period. Complications associated with it can be mechanical, infectious, gastrointestinal or metabolic. The aim of the study was to evaluate safety of post-operative feeding jejunostomy in different types of major upper gastrointestinal surgeries. It was a prospective study conducted during the period between August 2009 and September 2011. Post-operative cases of major upper gastrointestinal surgeries who receive jejunostomy feeds were included in the study. Sampling was done by convenient method with sample size of 50 cases. Post-operatively, patients were monitored according to standard orders of enteral nutrition. Total calorie and protein intake through feeding jejunostomy was calculated regularly, and complications were assessed in terms of frequency, type, duration, management, and final outcome in different types of upper gastro intestinal surgeries. Analysis was done using chi square test with the help of statistical package SPSS vers.13. P < 0.05 was considered as significant. Complications observed were gastrointestinal -8 (16 %), mechanical -6 (12 %), infectious -4 (8 %) and metabolic -4 (8 %). Duration of complications ranged from 1 to 7 days (mean, 4 days). All types of complications observed during study were less severe and could be managed by simple measurements. Haemoglobin, serum albumin and weight of the patient at the time of discharge were improved for all patients when compared to pre-operative values. All patients received target calories and proteins through feeding jejunostomy. Considering benefits of enteral feeding via jejunostomy tube with minor and acceptable complications, we conclude that feeding jejunostomy is a preferred route of nutritional administration in those who undergo major upper gastro intestinal surgeries.
空肠造口术通常作为上消化道大手术的附加操作,以便在术后进行肠内营养支持。与之相关的并发症可能是机械性、感染性、胃肠道或代谢性的。本研究的目的是评估不同类型的上消化道大手术中术后空肠造口喂养的安全性。这是一项在2009年8月至2011年9月期间进行的前瞻性研究。纳入了接受空肠造口喂养的上消化道大手术术后病例。采用方便抽样法,样本量为50例。术后,按照肠内营养的标准医嘱对患者进行监测。定期计算通过空肠造口喂养摄入的总热量和蛋白质,并根据不同类型上消化道手术中并发症的发生频率、类型、持续时间、处理方式及最终结局进行评估。借助统计软件SPSS 13.0版本,采用卡方检验进行分析。P < 0.05被认为具有统计学意义。观察到的并发症情况为:胃肠道并发症8例(16%)、机械性并发症6例(12%)、感染性并发症4例(8%)和代谢性并发症4例(8%)。并发症持续时间为1至7天(平均4天)。研究期间观察到的所有类型并发症均不太严重,可通过简单措施进行处理。与术前值相比,所有患者出院时的血红蛋白、血清白蛋白和体重均有所改善。所有患者通过空肠造口喂养均达到了目标热量和蛋白质摄入量。考虑到经空肠造口管进行肠内喂养的益处以及轻微且可接受的并发症,我们得出结论,空肠造口喂养是接受上消化道大手术患者营养支持的首选途径。