Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan.
Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan.
Int J Surg. 2019 Jan;61:69-75. doi: 10.1016/j.ijsu.2018.11.028. Epub 2018 Dec 9.
We have reported that perioperative and preoperative immunonutrition reduced infectious complications in patients undergoing pancreaticoduodenectomy; however, it is unclear whether perioperative immunonutrition has additional effects compared with preoperative immunonutrition. The present study evaluated whether perioperative, compared with preoperative, immunonutrition has additional effects on cell-mediated immunity and the infection rate after pancreaticoduodenectomy.
This was a prospective, randomized clinical trial conducted in our institution. Oral supplementation enriched with arginine, ω-3 fatty acids, and dietary nucleotides was given by enteral infusion to 30 patients before and after surgery (perioperative group); 30 patients received the same enriched formula before surgery and standard enteral nutrition following surgery (preoperative group). The primary endpoint was concanavalin (Con A)- or phytohemagglutinin (PHA)-stimulated lymphocyte proliferation on postoperative day (POD) 7, which is an index of cell-mediated immunity; the secondary endpoint was the postoperative infection rate.
There were no significant differences in Con A- or PHA-stimulated lymphocyte proliferation on POD 7 between the groups. There was no significant difference in the postoperative infection rate between the two groups. In the post hoc subgroup analysis, with respect to the effect on the infection rate, a significant interaction was found only between a long operative time and perioperative immunonutrition.
There were no additional effects of perioperative, compared with preoperative, immunonutrition on postoperative immunity and infectious complications in patients undergoing pancreaticoduodenectomy.
我们曾报道过围手术期和术前免疫营养可降低胰十二指肠切除术患者的感染并发症；然而，围手术期免疫营养是否比术前免疫营养具有额外的作用尚不清楚。本研究评估了与术前相比，围手术期免疫营养对胰十二指肠切除术后细胞介导免疫和感染率是否有额外的影响。
这是一项在我们机构进行的前瞻性、随机临床试验。术前和术后通过肠内输注给予富含精氨酸、ω-3 脂肪酸和膳食核苷酸的口服补充剂（围手术期组）；30 例患者术前给予相同的强化配方，术后给予标准肠内营养（术前组）。主要终点是术后第 7 天 ConA 或 PHA 刺激的淋巴细胞增殖，这是细胞介导免疫的一个指标；次要终点是术后感染率。
两组患者在术后第 7 天 ConA 或 PHA 刺激的淋巴细胞增殖无显著差异。两组患者的术后感染率无显著差异。在事后亚组分析中，就感染率的影响而言，仅在手术时间长和围手术期免疫营养之间发现了显著的交互作用。
与术前相比，围手术期免疫营养对胰十二指肠切除术后的免疫和感染并发症没有额外的作用。
