The Clinical Application Of Laparoscopic Jejunostomy In Thoracoscopic And Laparoscopic Radical Esophagectomy

ObjectiveEsophageal cancer is one of the most prevalent and malignant tumors.The most typical symptoms are progressive dysphagia and weight loss.Surgery is still the most important and preferred treatment for esophageal cancer,and minimally invasive surgery has gradually replaced traditional open surgery.Early postoperative nutritional support for esophageal cancer is mainly enteral nutrition,mainly through nasointestinal tube and jejunal fistula.Jejunostomy is the placement of the jejunal feeding tube from the abdominal wall into the jejunum.Nutrient solution directly enters the jejunum from the fistula.It is one of the most commonly used methods of early enteral nutrition.Its indications are extensive,especially patients with the difficulty of feeding and malnutrition requiring long-term nutritional support due to the upper digestive diseases.At present,there is no safe and effective consensus of early enteral nutrition for esophageal cancer after surgery.The purpose of this study is to compare the use of jejunum fistula and nasal nutrition for thoracoscopic and laparoscopic radical esophagectomy.Analyze the clinical data such as nutritional indicators and complications,discuss the advantages and disadvantages,and provide clinical reference for the selection of enteral nutrition methods after esophageal cancer.MethodsA retrospective collection of 115 patients undergoing thoracoscopic and laparoscopic radical esophagectomy at thoracic surgery in the Qilu Hospital of Shandong University from May 2016 to December 2016 was performed,95 patients in the jejunum group and 20 in the nasointestinal group.Record general conditions including sex,age,previous underlying diseases such as coronary heart disease,hypertension,diabetes,and tumor size,location,and pathological type,as well as body weight,BMI,preoperative albumin,prealbumin,and Hemoglobin according to admissions and preoperative examinations.Count the patients’ operation time and bleeding volume during the operation according to the surgical records.Count the patients’ daily drainage volume of gastric tube and extubation time,and calculate the average drainage volume and period of bearing gastric tube.The nutritional indicators were monitored postoperatively,including albumin,prealbumin and hemoglobin levels on the first,seventh,or the 9th day after surgery.The weights and postoperative BMI of the patients before normally oral intake were counted and the differences of related data were calculated.Postoperative complications were counted,including the incidence of pneumonia,anastomotic leakage,pleural effusion,arrhythmia,chylothorax,and complications associated with jejunostomy.The postoperative hospital stay,total length of stay,and mean were calculated according to admission,operation,and hospital discharge time.And use SPSS 22.0 software for statistical analysis.Results1.The operation time of the jejunum group was shorter than that of the nasointestinal group(P<0.05);2.The hemoglobin in the jejunum group was higher than that in the nasointestinal group after operation(P<0.05):3.Pneumonia in jejunum group(7/95 cases)was significantly lower than in nasointestinal group(5/20 cases)(P<0.05);4.Correlation analysis results:The type of nutrition tube was positively correlated with postoperative hemoglobin and correlated with the operation time and the incidence of pneumonia.In the jejunum group,the operation time was positively correlated with pneumonia and anastomotic leakage;The incidence of pneumonia is positively correlated with the duration of gastric tube retention.ConclusionsLaparoscopic jejunostomy operation is safe,simple,minimally invasive,and short time-consuming;Esophageal cancer patients’ postoperative albumin and hemoglobin via jejunal fistula were higher than those via nasointestinal tube,which is beneficial to improve postoperative hypoalbuminemia and anemia,fully exert the advantages of enteral nutrition,promote the recovery of gastrointestinal function,and facilitate rapid recovery after surgery;The jejunal fistula avoids irritation to the upper respiratory tract,which helps the patients to cough,bulge the lung,and effectively reduce the pulmonary complications,and has fewer postoperative complications than the nasointestinal tube.It is worthy of promotion in minimally invasive esophagectomy.