Exeter IBD group, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
Aliment Pharmacol Ther. 2017 Mar;45(5):660-669. doi: 10.1111/apt.13934. Epub 2017 Jan 20.
Few studies have reported the systematic use of exclusive enteral nutrition in the perioperative setting.
To test the hypothesis that exclusive enteral nutrition provides a safe and effective bridge to surgery and reduces post-operative complications, in adult patients with Crohn's disease requiring urgent surgery for stricturing or penetrating complications.
Patients treated with exclusive enteral nutrition prior to surgery were each matched with two control patients for disease behaviour, type of surgery, age at diagnosis and disease duration. Data on disease phenotype, nutritional status, operative course and post-operative complications were obtained.
Twenty-five per cent [13/51] patients treated with exclusive enteral nutrition avoided surgery. Exclusive enteral nutrition had no effect on pre-operative weight, but it significantly reduced serum CRP [median at baseline 36 (interquartile range, IQR: 13-91] vs. pre-operation 8 (4-31) mg/L, P = 0.02]. The median (IQR) length of surgery was shorter in patients pre-optimised with exclusive enteral nutrition than controls [3.0 (2.5-3.5) vs. 3.5 (3.0-4.0) hours respectively, P < 0.001]. Multivariable logistic regression analysis confirmed that going straight-to-surgery compared exclusive enteral nutrition pre-optimisation was associated with a ninefold increase in the incidence of post-operative abscess and/or anastomotic leak [OR 9.1; 95% CI (1.2-71.2), P = 0.04].
Exclusive enteral nutrition frequently down-stages the need for surgery in patients presenting with stricturing or penetrating complications of Crohn's disease; it is associated with a reduction in systemic inflammation, operative times and the incidence of post-operative abscess or anastomotic leak. Further trials are needed to elucidate how exclusive enteral nutrition may improve operative outcomes.
很少有研究报告围手术期系统使用肠外营养的情况。
检验以下假设，即对于需要紧急手术治疗狭窄或穿孔并发症的克罗恩病成年患者，肠外营养可作为安全有效的手术桥梁，减少术后并发症。
对术前接受肠外营养治疗的患者，分别为每位患者匹配 2 名对照患者，以匹配疾病行为、手术类型、诊断时年龄和疾病持续时间。收集疾病表型、营养状况、手术过程和术后并发症的数据。
25%（13/51）接受肠外营养治疗的患者避免了手术。肠外营养对术前体重没有影响，但显著降低了血清 CRP[中位数在基线时为 36（四分位距：13-91）mg/L，与术前相比为 8（4-31）mg/L，P=0.02]。与对照组相比，术前接受肠外营养优化的患者手术时间更短[中位数（四分位距）分别为 3.0（2.5-3.5）和 3.5（3.0-4.0）小时，P<0.001]。多变量逻辑回归分析证实，与术前接受肠外营养优化相比，直接手术与术后脓肿和/或吻合口漏的发生率增加 9 倍有关[比值比 9.1；95%可信区间（1.2-71.2），P=0.04]。
肠外营养常可降低出现狭窄或穿孔并发症的克罗恩病患者的手术需求；它与全身炎症反应减轻、手术时间缩短以及术后脓肿或吻合口漏的发生率降低有关。需要进一步的试验来阐明肠外营养如何可能改善手术结果。
