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目的探讨胃癌毕Ⅱ式吻合+肠间吻合术后,经输入袢两点造口双向置管早期和化疗期间肠内营养支持的可行性、安全性和应用价值。方法回顾性分析哈尔滨医科大学附属肿瘤医院2007年3月至2008年2月收治的62例行胃癌毕Ⅱ式吻合+肠间吻合术病人,实验组28例术中行输入袢两点造口双向置管,对照组34例术中经鼻咽置入胃管和空肠营养管。术后48h内开始行肠内营养支持。实验组化疗病人化疗期间经空肠造口营养管给予肠内营养支持。观察病人术后早期肠内营养支持期间不良反应、并发症及营养状况等,术后化疗病人观察营养和免疫指标等。结果对照组排痰不利和睡眠不佳的发生率显著高于实验组,差异有统计学意义(P<0.05)。对照组并发症发生率高于实验组,但差异无统计学意义(P>0.05)。经过7d的肠内营养,实验组前白蛋白水平显著高于对照组,白细胞水平显著低于对照组,差异有统计学意义(t=2.347,P<0.05;t=2.870,P<0.01)。术后化疗期间,实验组病人的营养状态和免疫指标显著好于对照组(P<0.05)。结论在胃癌毕Ⅱ式吻合+肠间吻合术后经输入袢两点造口双向置管行早期和化疗期间肠内营养支持是可行的、安全的,有利于病人术后早期恢复。为病人术后营养支持提供了一条重要的通道,值得临床大力推广。
Objective To investigate the feasibility, safety and application value of enteral nutrition support during the early stage of bi-directional catheterization and chemotherapy after two types of ostomy Ⅱ anastomosis plus intestine anastomosis. Methods Retrospective analysis of 62 patients with gastric cancer who underwent type Ⅱ anastomosis plus intestine anastomosis in the Affiliated Tumor Hospital of Harbin Medical University from March 2007 to February 2008 was retrospectively analyzed. Twenty-eight patients in the experimental group were enrolled in the bi-directional In the control group, 34 cases were treated with nasopharyngeal tube and jejunal nutrition tube. Enteral nutrition support began within 48 hours after surgery. Patients in the experimental group received enteral nutrition support via the jejunostomy feeding tube during chemotherapy. Observe the adverse reactions, complications and nutritional status of the patients after early enteral nutrition support, and observe the nutrition and immune indexes after chemotherapy. Results The incidence of adverse sputum and poor sleep in the control group was significantly higher than that in the experimental group (P <0.05). The incidence of complications in the control group was higher than that in the experimental group, but the difference was not statistically significant (P> 0.05). After 7 days of enteral nutrition, the albumin level in the experimental group was significantly higher than that in the control group, and the leukocyte level was significantly lower than that in the control group (t = 2.347, P <0.05; t = 2.870, P <0.01). During the postoperative chemotherapy, the nutritional status and immune indexes of the experimental group were significantly better than those of the control group (P <0.05). Conclusion It is feasible, safe and beneficial to the early recovery of postoperative patients with gastric cancer after completion of type Ⅱ anastomosis + intestine anastomosis. It provides an important channel for postoperative nutritional support of patients and is worthy of clinical promotion.