摘要目的 对比研究早期肠内营养与肠外营养对胆管癌术后患者恢复的临床应用价值.方法 56例胆管癌患者按随机数字表法分成肠内外联合营养组(EPN) 26例及全肠外营养组(PN)30例,所有患者以代谢支持为基础进行营养支持,分别统计两组患者术后3、7d白细胞计数及中性粒细胞百分比下降率、总胆红素下降率、肝酶(谷丙转氨酶及谷草转氨酶)下降率,肠功能(肛门排气排便)恢复时间,手术部位感染(腹腔、伤口)发生率,术后住院时间,胆漏的发生率及住院费用,并在两组之间作出对比分析.结果 EPN组在肠功能恢复时间[(51.2±4.4)h]、白细胞计数下降率(0.438 7 ±0.191 5)及中性粒细胞比率下降率(0.179 5 ±0.046 1)、胆红素下降率(0.502 5 ±0.153 5)、肝谷丙转氨酶下降率(0.688 1±0.113 3)、谷草转氨酶下降率(0.617 0±0.178 8)、住院费用[(87 852.37 ±9 127.04)元]均优于PN组[(72.0±12.9)h,0.090 5 ±0.120 3,0.083 4±0.036 8,0.201 5±0.077 8,0.251 6±0.419 0,0.230 9±0.437,(109 036.69±7 949.71)元,P＜0.05].但腹胀的发生率(42.31％)高于PN组(13.33％,P＜0.05).胆漏的发生率(7.69％)与PN组(13.33％)无明显区别(P＞0.05).结论 早期肠内营养对胆管癌术后患者恢复较肠外营养有明显的优势.

abstractsObjective To compare the clinical value of early enteral nutrition and parenteral nutrition therapy in postoperative patients of cholangiocarcinoma.Methods 56 cases of cholangiocarcinoma patients were randomly divided into early enteral nutrition group (EPN group) and parenteral nutrition group (PN group).All patients received nutritional support on the basis of metabolic support.Leukocyte count and neutrophil percentage decrease rate,total bilirubin decrease rate and hepatase (valley-C conversion) were counted at 3 and 7 days after operation.The decrease rate of aminase and glutamic oxaloacetic transaminase,recovery time of intestinal function (anal exhaust and defecation),incidence rate of surgical site infection (abdominal cavity and wound),hospitalization time after operation,incidence rate of bile leakage and hospitalization cost were compared between the two groups.Results The recovery time of intestinal function [(51.2 ±4.4) h],the decrease rate of leukocyte count (0.438 7 ±0.191 5) and neutrophil ratio (0.179 5 ± 0.046 1),the decrease rate of bilirubin (0.502 5 ± 0.153 5),alanine aminotransferase (ALT) (0.688 1 ±0.113 3),aspartate aminotransferase (AST) (0.617 0 ± 0.178 8) and hospitalization expenses [(87 852.37 ±9 127.04)yuan] in EPN group were better than those in PN group [(72.0 ± 12.9)h,0.090 5 ±0.120 3,0.083 4 ±0.036 8,0.201 5 ±0.077 8,0.251 6 ±0.419 0,0.230 9 ± 0.437,(109 036.69 ± 7 949.71) yuan,P ＜ 0.05].However,the incidence of abdominal distension (42.31％) was higher than that of PN group (13.33％,P ＜ 0.05).The incidence of bile leakage (7.69％) was not significantly different from that of PN group (13.33％,P ＞0.05).Conclusions Early enteral nutrition has obvious advantages in postoperative recovery of patients with cholangiocarcinoma.