Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
World J Surg. 2023 Mar;47(3):764-772. doi: 10.1007/s00268-022-06844-y. Epub 2022 Dec 16.
Although early enteral nutrition (EEN) is an accepted practice after pancreaticoduodenectomy (PD), the impact of EEN on postoperative complications or nutritional status remains unclear. We aimed to investigate the impact of EEN on delayed gastric emptying (DGE) and nutritional status after PD.
A total of 143 patients underwent PD between January 2012 and September 2020. We excluded patients who underwent a two-stage pancreatojejunostomy, in whom the enteral tube was accidentally pulled out, or with insufficient information in their medical records. The incidence of postoperative complications was compared between patients who received EEN (EEN group, n = 21) and those who did not (control group, n = 21) after propensity score matching. Univariate and multivariate analyses were performed to identify the risk factors affecting the incidence of these complications. Nutritional status was assessed at postoperative months 1, 3, and 6.
The incidence of grade B/C DGE in the EEN group was significantly lower than that in the control group (4.8% vs. 28.6%, p = 0.03). There was no significant difference in overall morbidity, incidence of any other postoperative complications, or all-grade DGE. In multivariate analysis, EEN was associated with a reduction in the incidence of grade B/C DGE (p < 0.01). In the analysis of nutritional status, EEN was significantly associated with better nutritional status at postoperative month 1.
EEN can lead to a lower clinically relevant DGE rate and better nutritional status in the early postoperative period in patients undergoing PD.
尽管胰十二指肠切除术（PD）后早期肠内营养（EEN）已被广泛接受，但 EEN 对术后并发症或营养状况的影响仍不清楚。我们旨在研究 EEN 对 PD 后胃排空延迟（DGE）和营养状况的影响。
共有 143 例患者在 2012 年 1 月至 2020 年 9 月期间接受了 PD。我们排除了接受两阶段胰肠吻合术的患者、肠内管意外拔出的患者或病历信息不足的患者。通过倾向评分匹配，比较接受 EEN（EEN 组，n=21）和未接受 EEN（对照组，n=21）的患者术后并发症的发生率。进行单因素和多因素分析，以确定影响这些并发症发生率的危险因素。在术后 1、3 和 6 个月评估营养状况。
EEN 组 B/C 级 DGE 的发生率明显低于对照组（4.8%比 28.6%，p=0.03）。总发病率、任何其他术后并发症的发生率或所有级别的 DGE 无显著差异。多因素分析显示，EEN 与 B/C 级 DGE 发生率降低相关（p<0.01）。在营养状况分析中，EEN 与 PD 后 1 个月时更好的营养状况显著相关。
EEN 可降低 PD 患者术后临床相关 DGE 发生率，并改善术后早期的营养状况。
