Wang Lidong, Tian Zhong, Liu Yuan
The Tenth General Surgery Department, Shengjing Hospital of China Medical University, Shenyang, P. R. China.
The Tenth General Surgery Department, Shengjing Hospital of China Medical University, Shenyang, P. R. China. Email:
Asia Pac J Clin Nutr. 2017 Jan;26(1):20-26. doi: 10.6133/apjcn.112015.05.
Following major upper gastrointestinal surgical procedures, early enteral nutrition to the jejunum is strongly recommended, either through a nasoenteric tube or a percutaneous transperitoneal jejunal feeding tube (jejunostomy). However, to date there has been no consensus as to the best enteral feeding strategy. Our aim was to determine the safest and most efficacious early enteral nutrition supplement strategy following major upper gastrointestinal operations.
PubMed, Embase and Cochrane Library databases were systematically searched for comparison of trials. The primary outcome analyzed was length of postoperative hospital stay, and secondary outcomes were: duration of enteral nutrition, time to resumption of normal oral intake, and tube dislodgement, tube leakage and tube obstruction complications. Weighted mean differences (WMDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CI).
A total of 5 studies were included with 420 patients in all. The length of hospital stay, duration of enteral nutrition and the time to resumption of normal oral intake were all significantly shorter in the nasoenteric group (p<0.05). There was no increase or reduction in the RR of tube obstruction between the nasoenteric and jejunostomy groups (p=0.5). The RR of tube dislodgement was increased in the nasoenteric group (p<0.05) while the RR of tube leakage was increased in the jejunostomy group (p<0.05).
A nasoenteric tube is more likely to be effective in early postoperative enteral feeding following major upper gastrointestinal operations.
在进行主要的上消化道外科手术后，强烈建议通过鼻肠管或经皮经腹膜空肠喂养管（空肠造口术）对空肠进行早期肠内营养。然而，迄今为止，对于最佳的肠内喂养策略尚无共识。我们的目的是确定主要上消化道手术后最安全、最有效的早期肠内营养补充策略。
系统检索PubMed、Embase和Cochrane图书馆数据库以比较试验。分析的主要结局是术后住院时间，次要结局包括：肠内营养持续时间、恢复正常经口摄入的时间以及管道移位、管道渗漏和管道阻塞并发症。计算加权平均差（WMDs）和风险比（RRs）以及95%置信区间（CI）。
共纳入5项研究，总计420例患者。鼻肠管组的住院时间、肠内营养持续时间和恢复正常经口摄入的时间均显著缩短（p<0.05）。鼻肠管组和空肠造口术组之间管道阻塞的RR没有增加或降低（p=0.5）。鼻肠管组管道移位的RR增加（p<0.05），而空肠造口术组管道渗漏的RR增加（p<0.05）。
在主要上消化道手术后的早期肠内喂养中，鼻肠管更有可能有效。
