Tarasova I A, Tshkovrebov A T, Bitarov T T, Boeva I A, Gardashov N M, Ivanova M V, Shestakov A L
Petrovsky National Research Center of Surgery, Moscow, Russia.
Sechenov First Moscow State Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2023(2):35-42. doi: 10.17116/hirurgia202302135.
To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries.
The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group (=121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints.
Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, <0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, <0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group (=0.034). Overall postoperative morbidity and mortality were similar.
Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.
探讨肠内营养作为食管和胃重建手术后康复治疗的一个组成部分。
本研究纳入了2010年至2020年间接受食管和胃重建手术的217例患者。在主要组（=121例）中，患者接受术后加速康复计划（ERAS）。早期肠内喂养包括微型空肠造口术和早期经口喂养对术后管理至关重要。对照组包括96例接受传统治疗的患者。主要终点是住院时间（LOS）和重症监护病房（ICU）停留时间。胃肠功能恢复（蠕动、排便、经口营养）、吻合口漏发生率和其他并发症为次要终点。
两组在性别、年龄、体重指数、诊断和合并症方面无差异。ERAS组术后LOS显著缩短（分别为14（12；15.8）天和9（6.3；12）天，<0.0001）。在同一组中，我们观察到ICU停留时间更短（分别为4.7（3.6；5.6）天和3.5（2；4）天，<0.001），无论有无吻合口漏，患者的蠕动恢复更早，吻合口的X线检查结果更好。ERAS组呼吸并发症的发生率更低（=0.034）。总体术后发病率和死亡率相似。
食管和胃重建手术后早期肠内和经口喂养可缩短住院时间并加速术后康复。
