Department of Otolaryngology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Otolaryngol Head Neck Surg. 2023 Oct;169(4):843-851. doi: 10.1002/ohn.335. Epub 2023 Mar 24.
To investigate the beneficial outcomes of intraoperative enteral feeding in free-flap regeneration after extended head and neck cancer resection and flap reconstruction surgery.
A pilot randomized, double-blind, placebo-controlled clinical trial.
Single tertiary care center.
Patients with advanced head and neck cancers requiring radical tumor resections and free-flap reconstruction were randomly assigned to receive intraoperative enteral nutrition feeding (100 kcal/100 mL at 10-20 mL/h) via a nasogastric tube during free-flap reconstruction (n = 28) or continue fasting (n = 28). The primary outcome was impaired free-flap regeneration that required surgical reintervention within 90 days after the operation. Participants were enrolled between April 2020 and January 2022; the 90-day follow-up ended in April 2022.
The incidence of total or partial flap failure was similar between the 2 groups (14.2% or n = 4 in each group), but the rate of wound dehiscence or edge necrosis was significantly reduced in the feeding group (n = 6 vs 0 for fasting vs feeding; absolute risk reduction, 25.0% [95% confidence interval, 6.9-43.0]%; p = 0.022). Hospital stay length was shorter (p = 0.042) and hand grip strength was better preserved (p = 0.025) in the feeding group. Plasma concentrations of interleukin (IL)-6 and IL-8 after the operation increased significantly more in the fasting group. Perioperative adverse events did not differ between the 2 groups.
Perioperative enteral feeding is a simple, safe, and effective approach to improve perioperative systemic catabolism and proinflammatory reactions, thereby enhancing early wound regeneration after major operations.
探讨在头颈部广泛切除及皮瓣重建术后，术中肠内喂养对游离皮瓣再生的有益作用。
一项前瞻性、随机、双盲、安慰剂对照临床试验。
单中心三级医疗机构。
将需要根治性肿瘤切除术和游离皮瓣重建术的晚期头颈部癌患者随机分为两组，分别在游离皮瓣重建术中（通过鼻胃管以 10-20mL/h 的速度输注 100kcal/100mL 的肠内营养）（n=28）或继续禁食（n=28）。主要结局是术后 90 天内需要手术干预的游离皮瓣再生不良。参与者于 2020 年 4 月至 2022 年 1 月入组，90 天随访于 2022 年 4 月结束。
两组总或部分皮瓣失败的发生率相似（各有 14.2%或 n=4），但喂养组的伤口裂开或边缘坏死的发生率显著降低（n=6 比禁食组的 0；绝对风险降低，25.0%[95%置信区间，6.9-43.0]；p=0.022）。喂养组的住院时间更短（p=0.042），握力保持更好（p=0.025）。术后，禁食组的白细胞介素（IL）-6 和 IL-8 血浆浓度升高更为显著。两组围手术期不良事件无差异。
围手术期肠内喂养是一种简单、安全、有效的方法，可以改善围手术期全身分解代谢和促炎反应，从而增强大手术后早期伤口再生。
