Postoperatively Early Application Of Enteral Nutrition In The Patients With Gastric Carcinoma

Postoperative patients with gastric cancer were unable to eat and in poor nutritional status, needing administration of nutritional support.Enteral and parenteral nutrition support are two effective postoperative nutritional method. In 1968, Dudrick first reported the application of parenteral nutrition for the treatment of surgical patients. It made patient who can not eat have a long-term survival and had successfully resolved the dysfunction problems of intestinal digestion and absorption due to a decrease in the length of intestine. It can also effectively correct the malnutrition of postoperative patients with cancer. With the wider use of parenteral nutrition, it is gradually revealed that it is hard to overcome the shortcomings. Since the 1970s, enteral nutrition has been gradually thought highly of and applicated by increasing number of clinical doctors, on the account of the shortcomings of parenteral nutrition. We have made significant development not only in theory and technology, but also in agents. It had become a very important therapeutic measure in the surgical treatment of the disease.For nearly 20 years, the use of enteral nutrition gradually exceed the use of parenteral nutrition. The traditional concept presumed that the trauma and stress after gastrointestinal surgery may cause gastrointestinal dysfunction for about three days,impeding digestion and absorption of nutrition. Consequently, parenteral nutrition is still the main method for the early postoperative gastrointestinal paitient home.But researchers have found that gastrointestinal tract paralysis after abdominal surgery for stomach and colon mainly and that the intestinal function has started to recover 6-12 hours after surgery. Postoperative enteral nutrition support was consistented with physiology, conducive to maintaining the integrity of intestinal structure and function, possibly improving the nutritional status of patients and may help reduce the incidence of postoperative complications, shorten the flatus time and hospital stay.Therefore, in recent years, some scholars have reported that there were several advantages to compare the enteral and parenteral nutrition as following: to help maintain the integrity of the structure and function of intestinal mucosa cells, reduce the release of endotoxin and the bacterial translocation; stimulate the secretion of gastrointestinal hormones, promote gastrointestinal motility and gallbladder contraction, recover the gastrointestinal function; inhibit metabolism hormones, lower hypermetabolism of intestine origin; correct intestinal mucosa ischemia, increase visceral blood flow; reduce the complications of inflammation and infectious.Nutritional support is better than parenteral nutrition and has fewer complications and costs; Nutrients can be absorbed from the portal vein by using enteral nutrition which is beneficial to the synthesis and metabolism of protein in liver and can also promote liver bloodflow, improve liver damage caused by malnutrition; In addition, parenteral nutrition needs to put the central venous catheter and care.It is simple and easy to operate Enteral nutrition importation.But so far there is no clear conclusion about the differences between effect of both methods and the social benefits resulted from them. Retrospective analysis of 78 clinical cases about 50 years of age of gastric cancer patients after gastrectomy using nutritional support between 2003 and 2006 in the Sino-Japanese Friendship Hospital were studied to investigate the effect of the enteral nutrition. The patients with no endocrine and metabolic diseases, no hepatic, renal insufficiency and serious heart and lung disease, no use of immunosuppressive agent or immunoenhancer for the first six months, no use of preoperative radiotherapy or chemotherapy before surgery, not to have splenectomy in the surgery, and the patient who do not have plasma or blood plasma albumin transfusion in nutritional support period and primary confirmed by pathology for advanced gastric cancer after surgery a first-time hospitalization are operated by the same group of physicians. 40 cases of EEN support and 38 cases of TPN support since the first day after operation were selected. The nasointestinal tube was placed on through the nose to the superior segment of the jejunum of gastric carcinoma patients during the surgery. Peptision was applied for patients 24 hours after surgery and TPN was used in the first day after surgery for TPN group with 8.5% Novamin for nitrogen source, and the glucose andlipid ratio was 1.5:1.0 and 20% intralipid for fat supply.With equal calories and nitrogen, the numerical indicators of nutrition and liver function of patients in the two groups at the day before operation and the eighth day after gastrectomy are recorded to compare own control and group comparision before and after support. Postoperative complications such as pulmonary infection, evacuation disorder, anastomotic fistula, hemorrhage were recorded to compare its incidence rate between the two groups. Simultaneously, the flatus time , the length of stay after operation and the cost of nutritional support were compared too. Results: The two groups had no significant differences in body weight, albumin, transferrin and prealbumin before surgery and both were lower at the eighth day after operation than before gastrectomy and EEN group was higher than TPN group(P<0.05). The decrease of EEN group was obviously less than TPN group. Albumin and transferrin of two groups at the eighth day after operation were lower than before gastrectomy, and there was no significant differences between the two groups(P> 0.05). Prealbumin of TPN group was significantly lower eight days after gastrectomy than before surgery(P <0.05). Prealbumin of EEN group was significantly higher than that of TPN group the eighth day after operation.There is no significant differences between two groups in glutamic - pyruvic transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP) and glutamyl transferase (GGT) before and after surgery. AKP of EEN groupundergone no significant changes before and after surgery, but AKP of TPN group (198.58±95.74) U/L after surgery was higher than before surgery(108.71±4 5.64 L) U/L, and the difference was significant (t=4.63, P = 0.00008). There are 2 cases of pulmonary infection in EEN group and 12 cases in TPN group (P=9.35,P=0.002233); 2 cases of evacuation disorder in EEN group and 11 cases in TPN group (χ2=8.73, P=0.003135), 3 cases of anastomotic fistula in EEN group and 14 cases in TPN group (χ2=9.84, P=0.001705) and only 2 cases of hemorrhage in TPN group(P=0.234099); Postoperative complication rate of EEN group was significantly lower than that of TPN group. Flatus time of EEN group was obviously earlier than that of TPN group (t=7.67,P<0.05). The length of stay after operation and the cost of nutritional support of EEN group were significantly less than that of TPN group[(t=5.73,P=0.000000),(t=10.53,P=0.000000)]..EEN support is a safe, practicable, reasonable and effective method for postoperative patients with gastric cancer. Compared with TPN support, it help patients to restore nutritional status, less effect the liver function and can reduce the incidence of postoperative complications. It also help patients recover flatus functional and shorten the length of stay and lower the cost.