| 景 巍,赵继波,赵燕红,刘 璇,毕仁杰,张 路.早期不同营养支持方式在腹腔镜直肠癌低位前切除术后患者中的应用比较及吻合口瘘的危险因素分析[J].,2023,(8):1555-1560 |
| 早期不同营养支持方式在腹腔镜直肠癌低位前切除术后患者中的应用比较及吻合口瘘的危险因素分析 |
| Application Comparison of Different Early Nutritional Support Methods in Patients after Laparoscopic Low Anterior Resection of Rectal Cancer and Analysis of Risk Factors of Anastomotic Leakage |
| 投稿时间：2022-08-28 修订日期：2022-09-23 |
| DOI：10.13241/j.cnki.pmb.2023.08.031 |
| 中文关键词: 肠内营养 肠外营养 腹腔镜直肠癌低位前切除术 吻合口瘘 危险因素 |
| 英文关键词: Enteral nutrition Parenteral nutrition Laparoscopic low anterior resection of rectal cancer Anastomotic leakage Risk factors |
| 基金项目:河北省医学科学研究课题计划项目（20210754） |
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| 中文摘要: |
| 摘要 目的：比较早期肠外营养、早期肠内营养在腹腔镜直肠癌低位前切除术后患者中的应用效果，并分析吻合口瘘的危险因素。方法：选择2020年3月~2022年2月期间我院接收的低位直肠癌患者216例，均行腹腔镜直肠癌低位前切除术。按照随机数字表法将患者分为对照组（早期肠外营养）和研究组（早期肠内营养），各为108例。观察对照组、研究组临床指标、营养指标、炎症因子水平，观察两组术后并发症发生率。统计两组吻合口瘘的发生率，根据术后是否发生吻合口瘘分为吻合口瘘组和无吻合口瘘组，经单因素和多因素Logistic回归模型分析腹腔镜直肠癌低位前切除术后患者发生吻合口瘘的影响因素。结果：研究组的术后排气、术后排便时间、住院时间均短于对照组，住院费用少于对照组（P<0.05）。干预2周后，两组白蛋白、前白蛋白、总蛋白升高，且研究组高于对照组（P<0.05）。干预2周后，两组血清白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平下降，且研究组低于对照组（P<0.05）。两组并发症发生率组间对比未见统计学差异（P>0.05）。单因素分析结果表明，吻合口瘘的发生与年龄、性别、糖尿病、体质量指数、与肛缘距离、术后腹泻、术前存在肠梗阻、术中腹腔灌注化疗、预防性回肠末端造口有关（P<0.05）。经多因素Logistic回归模型分析：性别为男性、与肛缘距离＜5 cm、术后腹泻、糖尿病、术前存在肠梗阻是术后吻合口瘘发生的危险因素，而术中腹腔灌注化疗、预防性回肠末端造口则是其保护因素（P<0.05）。结论：腹腔镜直肠癌低位前切除术后患者早期接受肠内营养，可减轻机体炎性应激反应，改善营养状况，缩短术后恢复时间。吻合口瘘是腹腔镜直肠癌低位前切除术常见的术后并发症之一，受到性别、与肛缘距离、术后腹泻、糖尿病、术前存在肠梗阻、预防性回肠末端造口、术中腹腔灌注化疗等多种因素的影响。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the application effect of early parenteral nutrition and early enteral nutrition in patients after laparoscopic low anterior resection for rectal cancer, and to analyze the risk factors of anastomotic leakage. Methods: 216 patients with low rectal cancer who were admitted to our hospital from March 2020 to February 2022 were selected.All patients underwent laparoscopic low anterior resection of rectal cancer. According to the random number table method, the patients were divided into control group (early parenteral nutrition) and study group (early enteral nutrition), 108 cases in each group. The levels of clinical indicators, nutritional indicators and inflammatory factors in the control group and the study group were observed. The incidence of postoperative complications in the two groups was observed. The incidence of anastomotic leakage in the two groups was statistically analyzed. According to the occurrence of anastomotic leakage, the two groups were divided into anastomotic leakage group and non-anastomotic leakage group. The influencing factors of anastomotic leakage in patients after laparoscopic low anterior resection of rectal cancer were analyzed by univariate and multivariate Logistic regression models. Results: The postoperative exhaust time, postoperative defecation time and hospital stay of the study group were shorter than those of the control group, and the hospitalization cost was less than that of the control group (P<0.05). 2 weeks after intervention, the levels of albumin, prealbumin and total protein in the two groups were increased, and the study group was higher than the control group(P<0.05). 2 weeks after intervention, the levels of serum interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the two groups were decreased, and the study group was lower than the control group(P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). The results of univariate analysis showed that the incidence of anastomotic leakage was associated with age, gender, diabetes mellitus, body mass index, distance from anal margin, postoperative diarrhea, preoperative intestinal obstruction, intraoperative intraperitoneal infusion chemotherapy, and prophylactic terminal ileostomy (P<0.05). Multivariate Logistic regression analysis showed that gender was male, distance from anal margin<5 cm, postoperative diarrhea, diabetes mellitus and preoperative intestinal obstruction were the risk factors for postoperative anastomotic leakage, while intraoperative intraperitoneal infusion chemotherapy and prophylactic terminal ileostomy were the protective factors(P<0.05). Conclusion: Early enteral nutrition after laparoscopic low anterior resection for rectal cancer can reduce inflammatory stress response, improve nutritional status, and shorten postoperative recovery time. Anastomotic leakage is one of the common postoperative complications of laparoscopic low anterior resection for rectal cancer, which is affected by gender, distance from anal margin, postoperative diarrhea, diabetes mellitus, preoperative intestinal obstruction, prophylactic terminal ileostomy, intraoperative intraperitoneal infusion chemotherapy and other factors. |
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