肠内营养支持联合术后加速康复对Ivor-Lewis术后食管癌患者营养状况、免疫功能及预后的影响
Effects of enteral nutrition support combined with enhanced recovery after surgery on the nutritional status, immune function, and prognosis of patients with esophageal cancer after Ivor-Lewis operation.
作者信息
Ding Haibing, Xu Jin, You Jijun, Qin Haifeng, Ma Haitao
机构信息
Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Thoracic Surgery, Second People's Hospital of Taizhou City, Taizhou, China.
出版信息
J Thorac Dis. 2020 Dec;12(12):7337-7345. doi: 10.21037/jtd-20-3410.
BACKGROUND
Esophageal cancer (EC) with a high incidence of malnutrition is a highly malignant digestive tract tumor. We investigated the effect of enteral nutrition (EN) support combined with enhanced recovery after surgery (ERAS) on the nutritional status, immune function, and prognosis of patients with EC after Ivor-Lewis operation.
METHODS
One hundred patients were randomly divided into the observation group (n=42) and the control group (n=58). The patients in observation group were treated with EN combined with ERAS intervention after Ivor-Lewis operation, and the patients in control group were treated with conventional postoperative EN intervention. The situation of operation, nutritional status, immune function recovery and prognosis between the two groups were compared.
RESULTS
There was no statistically significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). The chest tube removal time and oral feeding time of the observation group after operation were shorter than those of the control group (P<0.05). After intervention, serum albumin (ALB), transferrin (TF), pre-albumin (PA) and hemoglobin (Hb) levels in both groups were significantly decreased. These indexes were significantly higher in the observation group than in the control group (P<0.05). There were no significant changes in the levels of immunoglobulin (Ig) A, IgG, and IgM, or the numbers of CD3, CD4 and CD4/CD8 T cells in the observation group before and after intervention (P>0.05); however those indexes were significantly decreased in the control group after the intervention (P<0.05). Interestingly, the levels of IgA, IgM, IgG, CD3 T cells, CD4 T cells and CD4/CD8 T cells in the observation group were significantly higher than those in the control group after intervention (P<0.05). The incidence of pulmonary infection in the observation group was significantly lower than that in the control group. The postoperative exhaust time, postoperative defecation time and postoperative hospital stay were shorter in the observation group than in the control group (P<0.05). There was no significant difference in hospitalization cost between the two groups (P>0.05).
CONCLUSIONS
EN combined with ERAS was more beneficial to the improvement of nutritional status and immune function recovery of patients with EC after Ivor-Lewis operation. It also shortened the length of hospital stay.
背景
食管癌（EC）是一种高度恶性的消化道肿瘤，营养不良发生率很高。我们研究了肠内营养（EN）支持联合术后加速康复（ERAS）对接受Ivor-Lewis手术的EC患者营养状况、免疫功能和预后的影响。
方法
将100例患者随机分为观察组（n = 42）和对照组（n = 58）。观察组患者在Ivor-Lewis手术后接受EN联合ERAS干预，对照组患者接受传统术后EN干预。比较两组患者的手术情况、营养状况、免疫功能恢复情况和预后。
结果
两组患者的手术时间和术中出血量差异无统计学意义（P > 0.05）。观察组术后胸管拔除时间和经口进食时间均短于对照组（P < 0.05）。干预后，两组患者血清白蛋白（ALB）、转铁蛋白（TF）、前白蛋白（PA）和血红蛋白（Hb）水平均显著下降。观察组这些指标显著高于对照组（P < 0.05）。观察组干预前后免疫球蛋白（Ig）A、IgG和IgM水平以及CD3、CD4和CD4/CD8 T细胞数量无显著变化（P > 0.05）；然而，对照组干预后这些指标显著下降（P < 0.05）。有趣的是，干预后观察组IgA、IgM、IgG、CD3 T细胞、CD4 T细胞和CD4/CD8 T细胞水平显著高于对照组（P < 0.05）。观察组肺部感染发生率显著低于对照组。观察组术后排气时间、术后排便时间和术后住院时间均短于对照组（P < 0.05）。两组住院费用差异无统计学意义（P > 0.05）。
结论
EN联合ERAS更有利于Ivor-Lewis手术后EC患者营养状况的改善和免疫功能的恢复。它还缩短了住院时间。
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