[1]葛思堂,左芦根,邱权威,等.直肠癌预防性回肠造口还纳术后早期肠内营养对肠功能康复的影响研究[J].肠外与肠内营养杂志,2022,(02):89-92.[doi:10.16151/j.1007-810x.2022.02.006]
　GE Si-tang,ZUO Lu-gen,QIU Quan-wei,et al.Effects of early postoperative enteral nutrition on the recovery of intestinal function in rectal cancer patients after ileostomy retraction surgery[J].PARENTERAL & ENTERAL NUTRITION,2022,(02):89-92.[doi:10.16151/j.1007-810x.2022.02.006]
点击复制

直肠癌预防性回肠造口还纳术后早期肠内营养对肠功能康复的影响研究
分享到：

《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2022年02期
页码:
89-92
栏目:
论著
出版日期:
2022-03-10

文章信息/Info

Title:
Effects of early postoperative enteral nutrition on the recovery of intestinal function in rectal cancer patients after ileostomy retraction surgery
作者:
葛思堂1; 左芦根1; 邱权威1; 朱平胜1; 孙 洋2; 李 静2; 陈德利1; 李仕青1; 刘牧林1
蚌埠医学院第一附属医院，1.胃肠外科；2.检验科，安徽蚌埠 233004
Author(s):
GE Si-tang1;  ZUO Lu-gen1;  QIU Quan-wei1;  ZHU Ping-sheng1;  SUN Yang2;  LI Jing2;  CHEN De-li1;  LI Shi-qing1;  LIU Mu-lin1
1.School of Medicine, Yan'an University,Yan'an 716000, Shanxi,China；2.The College of Life Sciences, Northwest University, Xi'an 710069, Shanxi, China；3.Department of Digestive Surgery, Xijing Hospital of Digestive Diseases,Air Force Medical University, Xi'an 710032, Shanxi, China
关键词:
肠内营养治疗 ; 回肠造口还纳术 ; 直肠癌 ; 腹泻 ; 肠屏障功能
Keywords:
Enteral nutrition therapy;  Ileostomy retraction;  Rectal cancer;  Diarrhea;  Intestinal barrier function
分类号:
R735.3
DOI:
10.16151/j.1007-810x.2022.02.006
文献标志码:
A
摘要:
目的：探讨早期肠内营养（EEN）治疗对行造口还纳术的直肠癌预防性回肠造口病人术后康复过程的影响。 方法：收集2018年1月至2021年12月在蚌埠医学院第一附属医院胃肠外科行造口还纳术的直肠癌根治术后的病人资料，依据术后是否行EEN治疗分为观察组（EEN）和对照组（非EN）。观察组术后12 ~ 24 h开始给予EN治疗[20 ~ 30 kcal/(kg·d)]。比较两组术后腹泻、胃肠功能恢复、粪便钙卫蛋白和肠屏障功能等指标。 结果：所纳入的观察组（n = 46）和对照组（n = 44）一般资料未见显著差异（P > 0.05），两组术后均出现不同程度的腹泻，但观察组术后 5 d（χ2 = 25.760，P < 0.01）和 10 d（χ2 = 14.870，P < 0.01）仍存在腹泻的比例，以及需要使用止泻剂（χ2 =10.180，P = 0.001）的比例均低于对照组。同时，观察组恢复正常饮食时间（t = 5.701；P < 0.01）和术后住院日（t =7.343，P < 0.01）短于对照组。术后5 d，两组外周血炎症指标未见显著差异（P > 0.05），观察组病人粪便钙卫蛋白（t = 11.690，P < 0.01）、血清D-乳酸（D-Lactate；t = 6.160，P < 0.01）和肠脂肪酸结合蛋白（IFABP；t = 6.583，P < 0.01）水平低于对照组，且病人粪便钙卫蛋白水平与D-Lactate（r = 0.833，P < 0.01）和IFABP（r = 0.842，P < 0.01）均呈正相关关系。 结论：术后早期EN可有效改善回肠造口还纳术后腹泻症状、结肠炎症和肠屏障功能，加速术后康复进程。
Abstract:
Objective: To clarify the effects of early postoperative enteral nutrition (EN) on the recovery of gastrointestinal function after ileostomy retraction for rectal cancer. Methods: Patients with rectal cancer undergoing ileostomy retraction during January 2018 to December 2021 at the First Affiliated Hospital of Bengbu Medical College were collected and divided into observation group (EN group) and control group (non-EN group) according to whether early EN treatment was performed after surgery. The indexes of observation group were given EN treatment [20 ~ 30 kcal/(kg·day)] 12 ~ 24 h after surgery. The postoperative diarrhea, gastrointestinal function recovery, fecal calprotectin, and intestinal barrier function were compared between the two groups. Results: Although, there was no significant difference in demographic data (P > 0.05) between the observation group (n = 46) and the control group (n = 44), various degrees of diarrhea occurred in both groups after operation. The observation group had lower rates of diarrhea at 5 days (χ2 = 25.760, P < 0.01) and 10 days after operation (χ2 = 14.870, P < 0.01), as well as antidiarrheal agents needed (χ2 =10.180, P = 0.001) when compared to the control group. At the same time, the days returned to normal diet (t = 5.701, P < 0.01) and length of postoperative hospital stay (t = 7.343, P < 0.01) in the observation group were significantly shorter than those of the control group. At the fifth day after operation, there was no significant difference in the levels of peripheral inflammation index between the two groups (P > 0.05), but the levels of fecal calprotectin (t = 11.690, P < 0.01), serum D-lactic acid (t = 6.160, P < 0.01) and intestinal fatty acid-binding protein (t = 6.583, P < 0.01) in the observation group were lower than those of controls. Meanwhile, there was a significant positive correlation between fecal calprotectin and blood D-lactic acid (r = 0.833, P < 0.01) and IFABP (r = 0.842, P < 0.01) for patients enrolled in the present study. Conclusion: Early postoperative EN could effectively improve postoperative diarrhea, colitis, and intestinal barrier function after ileostomy retraction for patients with rectal cancer, while accelerating the process of postoperative rehabilitation.

参考文献/References:


[1] Bai D, Li L, Shen Z, et al. Risk factors for developing high output ileostomy in CRC patients: a retrospective study. BMC Surg, 2021;21(1):300.
[2] 吴 迪, 王 楠, 吴 涛, 等. 低位直肠癌前切除术后预防性回肠造口方式对转流性结肠炎发病及转归的影响. 中华结直肠疾病电子杂志, 2021, 10(1):61-69.
[3] Donahue CA, Chaudhry V, Mantilla N. Autologous fecal transplant for the treatment of microcolon due to diversion colitis . Tech Coloproctol, 2022, 26(1): 79-81.
[4] 吴 迪, 王 彬. 转流性结肠炎的诊断及治疗进展. 医学综述,2021, 27(04):733-737.
[5] 汤亲青, 乐建军, 曹先东. 胃癌术后应用肠内营养制剂的对比研究. 肠外与肠内营养, 2021, 28(3):147-151
[6] 邓凯元, 单 廷, 顾 琛, 等. 益生菌联合早期肠内营养支持对于胃癌病人术后康复的影响 . 肠外与肠内营养, 2021, 28(4):207-210, 215.
[7] Schiller LR, Pardi DS, Sellin JH. Chronic Diarrhea: Diagnosis and Management. Clin Gastroenterol Hepatol, 2017, 15(2): 182-193.e3.
[8] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209-249.
[9] 韩俊毅, 傅传刚. 低位直肠癌保肛手术方式及选择. 结直肠肛门外科, 2020, 26(01):5-10.
[10] Rosen HR, Boedecker C, Fürst A, et al. "Prophylactic" transanal irrigation (TAI) to prevent symptoms of low anterior resection syndrome (LARS) after rectal resection: results at 12 month fol‐low-up of a controlled randomized multicenter trial. Tech Colo‐proctol, 2020, 24(12):1247-1253.
[11] 刘忠臣, 卢列盛. 精准外科在结直肠癌根治术中的临床实践及意义. 中华结直肠疾病电子杂志, 2017, 6(1):10-14.
[12] 黎介寿, 江志伟. 加速康复外科的临床意义不仅仅是缩短住院日. 中华消化外科杂志, 2015, 14(1):22-24.
[13] 陈德利, 葛思堂, 左芦根, 等. 胃癌术后早期肠内营养对术后炎症反应及肠屏障功能的影响 . 肠外与 肠内营养, 2020, 27(4):222-225，229.
[14] 王 姗, 葛思堂, 周 英, 等. 序贯性早期肠内营养在胃癌病人术后康复治疗中的应用效果 . 肠外与肠 内营养, 2018, 25(2):102-106.
[15] 霍 蕊, 陈永侠, 葛思堂, 等. 应激性高血糖对胃癌术后肠内营养实施的影响及护理策略 . 肠外与肠内 营养, 2020, 27(3):166-170.
[16] 朱倩倩, 姜支农, 蒋 琦. 类似溃疡性结肠炎的旷置性肠炎临床病理学特征. 中华病理学杂志,2019, 48(04):321-323.
[17] 廖天佑, 欧阳满照. 改道性结肠炎治疗进展. 岭南现代临床外科, 2019, 19(01):110-114.
[18] Guyton K, Alverdy JC. The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol,2017, 14(1):43-54.
[19] Wang J, Wang L, Zhao M, et al. Effect of Early Enteral Nutrition Support Combined with Chemotherapy on Related Complications and Immune Function of Patients after Radical Gastrectomy. J Healthc Eng, 2022, 2022:1531738.
[20] 黎介寿. 肠内营养——外科临床营养支持的首选途径. 肠外与肠内营养, 2003, 10(3):129-130.
[21] 黎介寿 . 克罗恩病的营养支持 . 肠外与肠内营养, 2008, 15(3):129-130.
[22] van Rheenen PF, Aloi M, Assa A, et al. The Medical Management of Paediatric Crohn's Disease: an ECCO-ESPGHAN Guideline Update. J Crohns Colitis, 2020.

相似文献/References:

[1]王革非.克罗恩病并发肠梗阻的诊断与治疗[J].肠外与肠内营养杂志,2019,(01):1.[doi:10.16151/j.1007-810x.2019.01.001]
　WANG Ge-fei.Diagnosis and treatment of Crohn's disease complicated with intestinal obstruction[J].PARENTERAL & ENTERAL NUTRITION,2019,(02):1.[doi:10.16151/j.1007-810x.2019.01.001]
[2]左芦根,张 震,王 炼,等.腹腔镜胃癌根治术后早期肠内营养对术后康复和炎症反应的影响[J].肠外与肠内营养杂志,2023,(05):287.[doi:10.16151/j.1007-810x.2023.05.006]
　ZUO Lu-gen,ZHANG Zhen,WANG Lian,et al.Effects of early enteral nutrition on postoperative rehabilitation and inflammation after laparoscopic radical gastrectomy for gastric cancer[J].PARENTERAL & ENTERAL NUTRITION,2023,(02):287.[doi:10.16151/j.1007-810x.2023.05.006]

备注/Memo

备注/Memo:
基金项目 ：安徽省高校自然科学基金重点项目（KJ2020A0550）；国家自然科学基金（82070561）；蚌埠医学院杰出青年基金（2019byy?fyjq01） 作者简介 ：葛思堂，主治医师，医学硕士，从事消化系统肿瘤和营养治疗研究。E-mail：gesitang@163.com 通讯作者 ：左芦根，E-mail：zuolugen@126.com
更新日期/Last Update: 1900-01-01