Tian Weiliang, Yao Zheng, Xu Xin, Luo Shikun, Zhao Risheng
Department of General Surgery, Jinling Hospital, Nanjing, China.
Department of General Surgery, Jiangning Hospital, Nanjing, China.
Front Nutr. 2022 Oct 21;9:923191. doi: 10.3389/fnut.2022.923191. eCollection 2022.
The purpose of this study is to compare the effect of preoperative predigested formula vs. polymeric formula on bowel function recovery following definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF).
In this retrospective study, from January 2005 to December 2019, the patients with small intestinal EAF and receiving a DS were enrolled. During the preoperative treatment, each patient received enteral nutrition nasojejunal feeding and chyme reinfusion. The enrolled subjects were classified into two groups, based on their formula type: polymeric formula and predigested formula. Then, propensity scores matching (PSM) was used to further divide these patients into PSM polymeric formula group or PSM predigested formula group. The clinical characteristics of the groups were analyzed.
A total of 137 patients were finally enrolled, with 72 patients in the polymeric formula group and 65 patients in predigested formula group. The postoperative ileus was manifested in a total of 61 (44.5%) cases, with 27 (37.5%) in the polymeric formula group and 34 (52.3%) in the predigested formula group ( = 0.04). It was predicted that the polymeric formula could result in a reduction in postoperative ileus (OR = 0.47; 95% CI: 0.21-0.95; = 0.04). After 1:1 PSM, there were 110 patients included. The postoperative ileus was observed in 47 patients, with 18 (32.7%) in the polymeric formula group and 29 (52.7%) in the predigested formula group ( = 0.03). After PSM, the polymeric formula demonstrated a reduction in the incidence of postoperative ileus (OR = 0.42; 95% CI: 0.19-0.92; = 0.03).
Compared with predigested formula, the preoperative polymeric formula appears to be associated with earlier recovery of bowel function after DS for EAF.
本研究旨在比较术前预消化配方与整蛋白配方对小肠肠气瘘（EAF）确定性手术（DS）后肠功能恢复的影响。
在这项回顾性研究中，纳入了2005年1月至2019年12月期间患有小肠EAF并接受DS的患者。在术前治疗期间，每位患者接受肠内营养——鼻空肠喂养和食糜回输。根据配方类型，将纳入的受试者分为两组：整蛋白配方组和预消化配方组。然后，采用倾向评分匹配（PSM）将这些患者进一步分为PSM整蛋白配方组或PSM预消化配方组。分析了两组的临床特征。
最终共纳入137例患者，整蛋白配方组72例，预消化配方组65例。术后肠梗阻共出现61例（44.5%），整蛋白配方组27例（37.5%），预消化配方组34例（52.3%）（P = 0.04）。预计整蛋白配方可降低术后肠梗阻的发生率（OR = 0.47；95%CI：0.21 - 0.95；P = 0.04）。1:1 PSM后，纳入110例患者。观察到47例患者发生术后肠梗阻，整蛋白配方组18例（32.7%），预消化配方组29例（52.7%）（P = 0.03）。PSM后，整蛋白配方显示术后肠梗阻发生率降低（OR = 0.42；95%CI：0.19 - 0.92；P = 0.03）。
与预消化配方相比，术前整蛋白配方似乎与EAF行DS术后肠功能的更早恢复有关。
