Hogan Sophie, Reece Lauren, Solomon Michael, Rangan Anna, Carey Sharon
Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia.
JPEN J Parenter Enteral Nutr. 2022 Feb;46(2):411-421. doi: 10.1002/jpen.2120. Epub 2021 May 14.
Postoperative feeding practices vary after pelvic exenteration surgery because of the lack of nutrition research in this specific surgical area. Postoperative ileus (POI) is common after pelvic exenteration surgery, and early enteral feeding is often avoided because of the lack of evidence and the belief that this may induce POI in this patient cohort. The aim of this study was to determine the effects of early enteral feeding after pelvic exenteration surgery on return of bowel movement and POI.
A randomized controlled trial was conducted with patients undergoing pelvic exenteration surgery from November 2018 to June 2020. Forty participants received standard nutrition care (parenteral nutrition) and 47 participants received trophic enteral feeding (20 ml/h) via a nasogastric tube, in addition to standard care, until participants were upgraded to free fluids. Time to first bowel movement and rates of POI were the main outcome measures.
There was no significant difference between arms for time to first bowel movement; however, POI rates were significantly less in participants who were enterally fed (P = .036) in the per-protocol analysis. Regressions showed that the longer patients were restricted from an oral diet after surgery, the greater the time was to first bowel movement and the greater the postoperative complication rates (P < .0005).
Early enteral feeding can be commenced safely to improve gastrointestinal function after pelvic exenteration surgery.
由于在这一特定手术领域缺乏营养研究，盆腔廓清术后的喂养方式各不相同。盆腔廓清术后术后肠梗阻（POI）很常见，由于缺乏证据以及认为早期肠内喂养可能会在该患者群体中诱发POI，所以通常避免早期肠内喂养。本研究的目的是确定盆腔廓清术后早期肠内喂养对肠道蠕动恢复和POI的影响。
对2018年11月至2020年6月接受盆腔廓清术的患者进行了一项随机对照试验。40名参与者接受标准营养护理（肠外营养），47名参与者除接受标准护理外，还通过鼻胃管接受营养性肠内喂养（20毫升/小时），直至参与者升级为自由流质饮食。首次排便时间和POI发生率是主要结局指标。
两组的首次排便时间无显著差异；然而，在符合方案分析中，接受肠内喂养的参与者的POI发生率显著较低（P = 0.036）。回归分析表明，患者术后限制口服饮食的时间越长，首次排便时间越长，术后并发症发生率越高（P < 0.0005）。
盆腔廓清术后可安全地开始早期肠内喂养，以改善胃肠功能。
