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Enteral Nutrition is Superior to Total Parenteral Nutrition for Pancreatic Cancer Patients who Underwent Pancreaticoduodenectomy

對胰十二指肠切除的胰腺癌患者給予肠内营养优於全肠外营养

摘要


目的:本前瞻性研究的目的,在于比较全肠外营养和肠内营养,在胰腺癌胰十二指肠切除的患者之生化及临床指标方面的优劣。方法:从2006年到2008年间在天津第三中心医院接受胰十二指肠切除术的60名患者,随机分为两组,一组为肠内营养组,另一组为全肠外营养组。记录并分析两组的生化及临床指标差异。结果:术前1天及术后第1及第3天,全肠外营养组和肠内营养组患者在营养状态、肝肾功能和血糖方面无明显差异。但是术后第7天,两组之间在24小时尿氮,血清总蛋白、转铁蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶及血尿素氮、肌酐有明显差异。术后第14天,两组患者在24小时尿氮,血清总蛋白、转铁蛋白、视黄醇结合蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、总胆红素、直接胆红素、血尿素氮、肌酐和血糖方面均存在显著性差异。肠内营养组和全肠外营养组,胃排空延迟的发生率分别为0%和20%。再者,胰瘺和出血的发生率,在肠内营养组分别为3.6%和3.6%,在全肠外营养组則為26.7%和30%。结论:在胰腺癌胰十二指肠切除的患者中,肠内营养优于全肠外营养。

並列摘要


Objective: To determine the effects of total parenteral nutrition (TPN) and enteral nutrition (EN) on biochemical and clinical outcomes in pancreatic cancer patients who underwent pancreaticoduodenectomy. Methods: From the year 2006 to 2008, 60 patients who underwent pancreaticoduodenectomy in Tianjin Third Central Hospital were enrolled in this study. They were randomly divided into the EN group and the TPN group. The biochemical and clinical parameters were recorded and analyzed between the two groups. Results: There was no significant difference in the nutritional status, liver and kidney function, and blood glucose levels between the TPN and EN groups on the preoperative day, the 1st and 3rd postoperative days. However, on the 7th postoperative day, there was significant difference between the two groups in 24 h urinary nitrogen, serum levels of, total protein (TP), transferrin (TF), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transpeptadase (GGT), blood urea nitrogen (BUN) and creatinine (Cr). On the 14th postoperative day, there was a significant difference between the two groups in terms of urinary levels of 24 h nitrogen, TP, TF, retinol binding protein, ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, BUN, Cr, and glucose. The incidence of delayed gastric emptying in the EN and TPN groups was 0% and 20%, respectively. Moreover, the incidence of pancreatic fistulas and hemorrhages in the EN group were 3.6% and 3.6%, versus 26.7% and 30% in the TPN group, respectively. Conclusions: EN is better than TPN for pancreatic cancer patients who received pancreaticoduodenectomy.

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