Wang Honggang, Zuo Lugen, Zhao Jie, Dong Jianning, Li Yi, Gu Lili, Gong Jianfeng, Liu Qinghong, Zhu Weiming
Department of General Surgery, Taizhou People's Hospital, The Fifth Affiliated Hospital of Nantong University, No. 210 Yingchun Road, Taizhou, Jiangsu, China.
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, Jiangsu, China.
World J Surg. 2016 Aug;40(8):1993-2000. doi: 10.1007/s00268-016-3488-z.
The impact of preoperative enteral nutrition (EN) on postoperative complications and recurrence in Crohn's disease (CD) has not been investigated to date. The purpose of the present study was to determine the effect of preoperative exclusive EN on postoperative complications and recurrence after bowel resection in patients with active CD.
Patient data were obtained from a prospectively maintained database. 81 patients who received bowel resection for ileal or ileocolonic CD were studied. Before operation, 42 CD patients received exclusive EN for 4 weeks, and the other patients had no nutritional therapy. All patients were followed up regularly for 2 years after surgery, and ileocolonoscopy was performed every 6 months after bowel resection.
Patients receiving exclusive EN had a dramatic improvement of nutritional (BMI, albumin, pre-albumin, and Hb) and inflammatory (CRP and CDAI) status compared with baseline after the EN therapy for 4 weeks (P < 0.05). Furthermore, significantly lower incidence of both infectious and non-infectious complications was observed in patients receiving exclusive EN compared with those received no nutritional therapy (P < 0.05). Exclusive EN therapy for 4 weeks significantly reduced endoscopic recurrence rates after resection for CD 6 months after operation. However, during the 2-year follow-up, incidence of clinical recurrence was similar in both groups (P > 0.05).
Preoperative exclusive EN therapy for 4 weeks reduced postoperative complications, which may be associated with improvement of nutritional and inflammatory status in patients with active CD.
术前肠内营养（EN）对克罗恩病（CD）术后并发症及复发的影响迄今尚未得到研究。本研究的目的是确定术前全肠内营养对活动期CD患者肠切除术后并发症及复发的影响。
从一个前瞻性维护的数据库中获取患者数据。研究了81例行回肠或回结肠CD肠切除术的患者。术前，42例CD患者接受了4周的全肠内营养，其他患者未接受营养治疗。所有患者术后定期随访2年，肠切除术后每6个月进行一次回结肠镜检查。
接受全肠内营养的患者在接受4周肠内营养治疗后，与基线相比，营养状况（BMI、白蛋白、前白蛋白和血红蛋白）和炎症状态（CRP和CDAI）有显著改善（P<0.05）。此外，与未接受营养治疗的患者相比，接受全肠内营养的患者感染性和非感染性并发症的发生率显著降低（P<0.05）。4周的全肠内营养治疗显著降低了CD术后6个月切除术后的内镜复发率。然而，在2年的随访中，两组的临床复发率相似（P>0.05）。
术前4周的全肠内营养治疗可减少术后并发症，这可能与改善活动期CD患者的营养和炎症状态有关。
