| Aims: Nutritional support is an important part ofpancreaticoduodenectomy postoperative treatment, parenteral nutritionsupport are still in use as a traditional postoperative nutritional support.Enteral nutrition has many advantages, such as physiological, the use of safe,nutritious, inexpensive and simple method with few complications, protectedthe intestinal mucosal barrier function, and gradually accepted by clinicians.However, some studies and clinical observations found that patients toleratedearly postoperative enteral nutrition is not ideal, especially in the earlypostoperative enteral nutrition tolerance. Pancreatoduodenectomy patients inclinical enteral joint nutrition is early to give a small amount of enteralnutrition, the rest by parenteral nutrition supplement, and then gradually overthe full enteral nutrition nutrition. In this paper, we compared the earlyrehabilitation impacts which pancreatoduodenectomy patients given enteralnutrition and total parenteral nutrition (TPN). Explorepancreatoduodenectomy early postoperative reasonable nutritional support.Methods: We retrospectively analyzed43cases ofpancreaticoduodenectomy patients' clinical data between January2011toJanuary2012in the Department of Hepatobiliary Surgery, Second Hospital ofHebei Medical University. The exclusion of one case ofpancreaticoduodenectomy patient with benign disease (chronic pancreatitis).The remaining42cases, aged between37to74years, including20males and22females, male to female ratio of1:1.1. Primary diseases, including12casesof pancreatic cancer,10cases of duodenal cancer, common bile duct cancer in9cases,11cases of ampullary carcinoma were confirmed by pathology results.Including12cases of patients with diabetes. The patients were randomlydivided into to EN+PN group and TPN group. Preoperative nasal placed IA sac jejunal catheter (disposable nasogastric tube) in the EN+PN group patients,the nutrient tube and gastic tube were separated during the surgery, thenutrient tube into the the gastroenterostomy output loop, gastric tube into theinput loop of the gastrointestinal anastomosis. In18cases afterpancreatoduodenectomy patients,12hours after surgery to patients withparenteral nutrition support, at the same time, Weaver enteral nutrition powder(AA, prepared by the warm water) was slowly trickle through the nasojejunalfeeding/nutrient tube, and gradually reduce the amount of parenteral nutrition,increase the amount of enteral nutrition, the final transition to full enteralnutrition. TPN group of24cases of patients before surgery by peripheralvenous puncture to place peripherally inserted central catheter (PICC) tube,only intravenous hyperalimentation therapy through PICC tube. The twogroups were given the same total calories in every day. The two groups werecompared clinical indicators, such as flatus, postoperative complications,blood cell count, serum albumin changes, length of stay and hospital spending.Data are expressed as means±SD. Values were subjected to Student's t-test,one-way ANOVA or exact probabilities according to the number of groupscompared. The significance level was set at P<0.05.Results: General indicators: the patient gender, average age (years), theproportion of patients with diabetes, the proportion of the lesion, the averageoperative time were not significant differently in the EN+PN group and TPNgroup (P>0.05). Clinical observations: there were no deaths in two groups.The average flatus3.11±1.32days in EN+PN group was significantlyshortener than that of TPN group (the days of3.11±1.32vs.4.92±1.28,P<0.05). There were no gastrointestinal anastomotic leakage patients in theEN+PN group and TPN group. In EN+PN group, there was one case ofpatients with bile leakage, two cases of patients with pancreatic leakage, onecases of patients with incisional liquefied infected, one case of patients withgastroparesis. In TPN group, there was two cases of patients with bile leakage,one case of patients with pancreatic leakage, zero case of patients withincisional liquefied infected, one case of patients with gastroparesis. There were no significantly difference on gastrointestinal anastomotic leak, bileleakage, pancreatic fistula, incision liquefaction infection and gastroparesisincidence. The white blood cell count average was no significant differencebetween the EN group and TPN group patients (6.19±1.22vs.6.14±1.37,P>0.05). In preoperative, the serum albumin average was no significantdifference between the EN+PN group and TPN group patients (38.19±2.913g/L vs.37.858±2.04g/L, P>0.05). Setting the white blood cell values higherthan the upper limit of normal (10×109/L) as a positive results in postoperativeseven days. The positive results were2cases and5cases in the EN+PNgroups and TPN groups, respectively. There were no significanly difference(P>0.05by the exact probabilities). The serum albumin levels in postoperativewas significantly decreased compareed with those of the preoperative. Inpostoperative seven days, the serum albumin average was no significantdifference between the EN+PN group and TPN group patients (35.7±2.764g/L vs.35.7±2.433g/L, P>0.05). The duration of hospitalization and hospitalspending: the duration of hospitalization was no significant difference betweenthe EN+PN group and TPN group patients (the days of33.61±12.36vs.39.75±14.32, P>0.05). The average of hospital spending in EN+PN group wassignificantly higher compareed with those of the TPN group patients(6.555±1.5453ten thousand yuan vs.8.967±2.2683ten thousand yuan,P<0.01), there were significant difference between the two groups.Conclusions: In this study, we found that the pancreatoduodenectomypatients, compared with total parenteral nutrition, the enteral nutrition andparenteral nutrition has the following advantages: lower hospital spending,conducive to the recovery of gastrointestinal function in patients with andmaintain the stability of the nutritional status indicators, and reduce the risk ofpostoperative complications. |
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