Brister S J, Chiu R C, Brown R A, Mulder D S
Ann Thorac Surg. 1984 Dec;38(6):617-21. doi: 10.1016/s0003-4975(10)62320-x.
The coexistence of malignancy and dysphagia makes nutritional deprivation especially serious in patients with carcinoma of the esophagus. Intravenous hyperalimentation (IVH) is often given and should be of particular value in these patients. Sixty-four patients with carcinoma of the esophagus seen between January, 1975, and February, 1982, were studied retrospectively during their first hospitalization for the disease. Thirty-seven patients received IVH, and 27 did not. There were no significant differences at the time of admission to the hospital between the two groups with respect to age, sex, pathological status, and location of the carcinoma. Also, there was no difference in the incidence of hypoalbuminemia (less than 3 gm/dl) or lymphocytopenia (less than 1,500/mm3). More patients in the IVH group underwent surgical resection of the esophagus. Surgical intervention did not significantly influence hospital mortality. The IVH therapy reduced weight loss (p less than 0.05), but was associated with an increased incidence of pulmonary sepsis (p less than 0.05) and longer hospital stay. The incidence of hypoalbuminemia and lymphocytopenia increased between admission and the end of hospitalization, but it did not significantly differ between the groups. Thus, one cannot assume the effectiveness of IVH in this clinical setting, as its value was not demonstrated in this retrospective series. A prospective randomized study is warranted in view of the high cost and the doubtful clinical impact of an IVH regimen in patients with carcinoma of the esophagus.
恶性肿瘤与吞咽困难并存使得食管癌患者的营养缺乏问题尤为严重。常采用静脉高营养疗法（IVH），且该疗法对这些患者应具有特殊价值。对1975年1月至1982年2月期间收治的64例食管癌患者首次住院时的情况进行了回顾性研究。37例患者接受了IVH治疗，27例未接受。两组患者入院时在年龄、性别、病理状态和肿瘤位置方面无显著差异。低白蛋白血症（低于3克/分升）或淋巴细胞减少症（低于1500/立方毫米）的发生率也无差异。IVH组中更多患者接受了食管手术切除。手术干预对医院死亡率无显著影响。IVH治疗减轻了体重减轻（p<0.05），但与肺部感染发生率增加（p<0.05）和住院时间延长有关。入院至住院结束期间，低白蛋白血症和淋巴细胞减少症的发生率增加，但两组之间无显著差异。因此，在这种临床情况下不能假定IVH的有效性，因为在这个回顾性系列研究中其价值未得到证实。鉴于IVH方案成本高昂且对食管癌患者的临床影响存疑，有必要进行一项前瞻性随机研究。
