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食管癌术后吻合口瘘患者肠内外营养的比较
作者:陈晨1  莫然2 
单位:1. 南京大学医学院附属鼓楼医院临床营养科, 江苏 南京 210008;
2. 南京大学医学院附属鼓楼医院整形美容烧伤科, 江苏 南京 210008
关键词:食管癌 吻合口瘘 静脉营养 空肠造瘘 
分类号:R735.1
出版年·卷·期(页码):2020·39·第三期(270-273)
摘要:

目的:探讨食管癌术后吻合口瘘患者营养干预治疗方式对其预后的影响。方法:回顾性分析2008年1月至2019年1月本院心胸外科56例吻合口瘘患者的临床资料,根据营养方式分为静脉营养组(n=18)及空肠造瘘组(n=38),对吻合口瘘患者的转归进行多因素回归分析。结果:与空肠造瘘组相比,术后静脉营养组呼吸机时间较长[(18.31±43.24) h vs (6.35±5.09) h,P=0.024]。静脉营养组3例患者接受二次手术(P=0.029)。多因素回归分析显示静脉营养(P=0.036)可能是死亡的影响因素之一。结论:对食管癌根治术患者行空肠造瘘在吻合口瘘出现后可有效维持体内营养平衡,弥补能量消耗,显著改善预后。

Objective:To explore the effects of treatment methods and nutritional interventions on prognosis of patients with anastomotic fistula after esophagectomy for esophageal cancer. Methods:The clinical materials of 56 patients with anastomotic fistula after esophagectomy for esophageal cancer in department of cardiothoracic surgery in our hospital from January 2008 to January 2019 were retrospectively analyzed. According to the way of nutritional support, the patients were divided into two groups:parenteral nutrition group (n=18) and enteral nutrition group with jejunostomy (n=38). A multivariate regression analysis of the outcome of the patients with anastomotic fistula was performed. Results:Compared with the enteral nutrition groups, the respirator time after esophagectomy in parenteral nutrition group was longer. 3 patients in parenteral nutrition group underwent secondary surgery (P=0.029). Multivariate regression analysis showed that parenteral nutrition (P=0.036) might be one of the factors affecting death. Conclusion:Jejunostomy during esophagectomy for esophageal cancer can effectively maintain the nutritional balance in the body after the occurrence of anastomotic fistula, compensate for energy expenditure, and significantly improve the prognosis of patients with anastomotic fistula.

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