| Esophageal cancer and lung cancer are most common malignant tumors in the thoracic surgery.Esophageal cancer is a malignant tumor occurring in the esophageal epithelial tissue,whose incidence of esophageal cancer ranks sixth,and mortality rate ranks fourth among all the malignant tumors in China.The particular anatomical and physiological functions of esophagus result in the high incidence of malnutrition in esophageal cancer patients.Previous studies reported cthat 60-85%of esophageal cancer patients suffered from malnutrition varying degrees,which ranked the first among all tumors.Early postoperative nutrition support in esophageal cancer patients has become the focus of more and more scholars.Currently,there are many studies centered on the comparision of clinical efficacy between Multi-Nutrition(MN)and Parenteral Nutrition(PN)in patients undergoing esophageal cancer,yet the conclusions are not still compatible.Adequate energy and protein are important factors to ensure the nutritional efficacy and clinical outcome.Insufficient energy and protein supply can cause tissue consumption,affect organ structure and energy supply,and thus result in a poor prognosis of patients.Normally,esophageal cancer surgery leads to the loss of normal anatomical structure and physiological function of the digestive tract.During the treatment of early enteral nutrition(EEN),a variety of feeding intolerance will occur among patients,which makes enteral nutrition(EN)difficult to meet the physical requirement of energy and protein consumption.Furthermore,long time energy and protein negative balance will increase the incidence of complications and mortality.Sequential nutritional support,which transites the nutrition support from the combination of EEN and PN to the full EN,emphasizes the joint application of EN and PN during the early stage,then gradual transition to the full dose of EN in addition with the halt of PN.PN provides insufficient energy and protein for EN.Compared with unsequential nutritional support,this treatment is able to meet the basic physical demand,which is beneficial to the normal tissue metabolism and organ function sustention.As the the most common malignant tumor in thoracic surgery,lung cancer demonstrates the highest mortality among cancers.Surgery is the major treatment for early lung cancer.However,lung cancer surgical site infection may occur due to the large amounts of hosted bacteria flora in surgical site.Those infections can be prevented by antibiotics.Perioperative antibiotics are capable of declining the incidence of surgical site infection and improving surgery safety.Neverthless,irrational use of perioperative antibiotics will not only cause the generation of drug-resistant strains and alternation of flora,but also extend the length of hospitalization and increase the hospital expenses.Objective 1.Evaluate the clinical efficacy of multi-nutrition(MN)and parenteral nutrition(PN)for perioperative esophagus cancer patients by meta-analysis;2.Compare the clinical efficacy of sequential nutritional support therapy and non-sequential nutritional support therapy for perioperative esophageal cancer in thoracic surgery;Explore whether sequential nutritional support therapy benefits perioperative esophageal cancer patients in thoracic surgery;3.Investigate the cost-effectiveness analysis of different prophylactic antibiotics for lung cancer patients during perioperative period.Methods 1.Published trails related to randomized controlled trials(RCTs)on comparision between multi-nutrition and PN for esophagus cancer patients after esophagectomy were retrieved by searching PubMed,EMbase,The Cochrane Library,Web of Science,WanFang Data and CNKI.The retrieval period is from the database construction to May 31,2018.Two reviewers independently screened literature based on the inclusion and exclusion criteria,extracted data,and evaluated the risks of included studies bias.Then meta-analysis was performed by using RevMan 5.3 software.2.A retrospective study was conducted on 52 patients undergoing radical resection of esophageal cancer from February 22,2018 to April 30,2018 in Jiangsu Cancer Hospital.According to whether transite from EEN and PN to total enteral nutrition or not,52 patients were divided into the sequential nutrition group and the non-sequential nutrition group.Then,the clinical outcome indexes(defecation time,postoperative complications,liver function,postoperative hospitalization time and total hospitalization cost)and nutrition indexes(albumin,prealbumin,etc.)were compared between the two groups.3.A total of 84 patients with lung cancer were selected in Jiangsu Cancer Hosiptal from August 2016 to November 2017.Patients were divided into group A,group B,group C based on the perioperative antibiotic use.The durations of operative time and postoperative hospital staying,the temperature before and after the surgeries,the time of body temperature recovery,the rate of incision infection,the treatment of antibiotics and the cost of antibiotics were compared among those three grousps.Results 1.Data from the 15 RCTs,with 1514 patients,were included in this meta-analysis.The results showed that the MN could improve postoperative levels of albumin,prealbumin,and transferrin compared with the PN.Furthermore,the restore time of anal exhaust and postoperative hospital staying were declined.The incidences of pulmonary infection and wound infection after surgery were also decreased.However,there was no significant difference in incidence of anastomotic leakage and gastrointestinal symptoms between two groups;2.There was no statistically significant difference between the sequential nutrition group and the non-sequential nutrition group on the aspects of the first defecation time,nutrition indexes,postoperative complications,liver function,and postoperative hospitalization time(P>0.05).Conversely,sequential nutrition could reduce the consumption of human albumin during hospitalization.(P<0.05);3.There was no significant difference on preoperative and postoperative temperature,operation time and incisional infection rate among the three groups(P>0.05).However,compared with the other two groups,in group A,the duration of antibiotics was significantly shorter and the cost of antibacterial drugs decreased significantly(P<0.05).Conclusion 1.The MN could extensively improve the nutritional level of esophageal cancer patients after esophagectomy,and reduce the incidence of postoperative complications.2.Sequential nutrition did not improve the postoperative nutritional status of patients compared with non-sequential nutrition group,but it could reduce the amount of albumin in human blood during hospitalization and save medical resources.3.The short course of cefazolin sodium regimen was not only cost-less,but also effective in preventing postoperative infection and reducing the dosage of antibiotics. |
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