Zapas J L, Karakozis S, Kirkpatrick J R
Department of Surgery, Washington Hospital Center, Washington, DC 20010, USA.
Surgery. 1998 Oct;124(4):715-9; discussion 719-20. doi: 10.1067/msy.1998.92380.
The effectiveness of enteral feeding in maintaining postoperative nutrition has led some investigators to recommend prophylactic jejunostomy at the time of any high-risk abdominal operation. A failed procedure in this setting weighs heavily on the side of risk without identifiable benefit.
A benefit/risk analysis comparing complication rate, avoidance of parenteral nutrition, and discontinuation of jejunostomy feeding was performed in 92 patients. These patients were judged retrospectively to be undergoing either a prophylactic jejunostomy placed at the time of operation for another serious condition (group A) or therapeutic jejunostomy alone (group B) during a 3-year period (1993 to 1996). Classification as prophylactic or therapeutic was determined by the surgeon's preoperative intent.
Avoidance of parenteral nutritional support, a goal of prophylactic jejunostomy, was not achieved in 39% of the patients. Patients in group A had a 5-fold increase in the risk of premature discontinuation of enteral feeds when compared with group B (P < .03). The complication rate was higher in group A (41%) than in group B (26%). Four life-threatening complications occurred in group A; all required reversal of the feeding jejunostomy.
This study suggests that the benefit/risk ratio of prophylactic jejunostomy is low. This adds weight to the notion that this procedure be abandoned in favor of other forms of nutritional support.
肠内营养在维持术后营养方面的有效性促使一些研究者建议在任何高风险腹部手术时进行预防性空肠造口术。在这种情况下，手术失败会带来很大风险且无明显益处。
对92例患者进行了效益/风险分析，比较了并发症发生率、避免肠外营养以及停止空肠造口喂养的情况。这些患者在1993年至1996年的3年期间，经回顾性判断，一部分是因其他严重疾病在手术时进行预防性空肠造口术（A组），另一部分仅进行治疗性空肠造口术（B组）。预防性或治疗性的分类由外科医生的术前意图决定。
39%的患者未实现预防性空肠造口术的目标，即避免肠外营养支持。与B组相比，A组患者肠内喂养过早停止的风险增加了5倍（P <.03）。A组的并发症发生率（41%）高于B组（26%）。A组发生了4例危及生命的并发症；所有这些并发症都需要将喂养空肠造口术逆转。
本研究表明预防性空肠造口术的效益/风险比很低。这进一步支持了放弃该手术而采用其他形式营养支持的观点。
