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目的探讨早期经口进食在腹腔镜下远端胃癌根治术后应用的安全性与可行性。方法将2015年5月至2016年2月期间收治的150例胃癌患者按照随机对照的方法分为早期经口进食组和传统进食组,观察并分析腹腔镜下远端胃癌根治术后2组患者的术后并发症(切口感染、炎性肠梗阻、吻合口漏、肺部感染、胃潴留等)、进食耐受性(恶心、呕吐和重新置入胃管)、营养状况(血清白蛋白、前白蛋白)、免疫功能(Ig A、Ig G、Ig M)、胃肠道功能恢复(术后首次肛门排气及排便时间)、术后住院时间及术后住院费用情况。结果 1本研究共纳入139例胃癌患者,早期经口进食组72例,传统进食组67例,2组患者的性别、年龄、术前1 d(以下简称术前)体重指数、TNM分期、血清白蛋白、前白蛋白、Ig A、Ig G、Ig M等一般资料比较差异均无统计学意义(均P>0.05)。2 2组患者均治愈出院,无围手术期死亡患者。2组患者的手术时间、术中失血量及术后住院费用比较差异均无统计学意义(P>0.05)。早期经口进食组的术后首次排气时间、首次排便时间及术后住院时间均明显短于传统进食组(P<0.05)。3早期经口进食组患者术后第7 d时血清白蛋白、前白蛋白及Ig A均明显高于传统进食组(P<0.05);2组Ig G和Ig M比较差异均无统计学意义(P>0.05)。4早期经口进食组和传统进食组患者可耐受患者的比例分别为91.7%(66/72)和94.0%(63/67),2组间比较差异无统计学意义(校正χ~2=0.044,P=0.833)。早期经口进食组患者虽然有2例因恶心、腹胀需重置胃管,但经3 d保守治疗后均已治愈。5早期经口进食组和传统进食组总并发症分别为10例(13.9%)和11例(16.4%),2组总并发症发生率比较差异无统计学意义(χ~2=0.173,P=0.677)。所有并发症经积极治疗后均治愈出院。102例患者术后获得随访,随访时间为1~6个月,无因术后并发症再次入院患者。结论腹腔镜下远端胃癌根治术后患者早期经口进食是安全、可行的,在不增加并发症发生的前提下,改善了患者营养状况及机体免疫功能,促进了肠道功能恢复,并缩短了术后住院时间。
Objective To investigate the safety and feasibility of early oral intake of laparoscopic distal gastric cancer after radical operation. Methods One hundred and fifty patients with gastric cancer who were admitted between May 2015 and February 2016 were randomly divided into early oral intake group and traditional feeding group. Two groups of patients with radical gastric cancer after laparoscopic radical gastrectomy were observed and analyzed. Postoperative complications (incisional infection, inflammatory bowel obstruction, anastomotic leakage, pulmonary infection, gastric retention, etc.), eating tolerance (nausea, vomiting and repositioning of the stomach), nutritional status (serum albumin, Prealbumin), immune function (IgA, IgG, IgM), gastrointestinal function recovery (first anal exhaust and defecation time after surgery), postoperative hospital stay and postoperative hospitalization. RESULTS: A total of 139 patients with gastric cancer were enrolled in this study. There were 72 cases of early oral intake group and 67 cases of traditional feeding group. The gender, age, preoperative 1 day (preoperative) body mass index, TNM stage, serum Albumin, prealbumin, Ig A, Ig G, Ig M and other general information were no significant difference (all P> 0.05). 2 2 patients were cured and discharged without perioperative deaths. There was no significant difference in operation time, intraoperative blood loss and postoperative hospitalization between the two groups (P> 0.05). In the early oral intake group, the first postoperative exhaust time, the first defecation time and the postoperative hospital stay were significantly shorter than those in the traditional feeding group (P <0.05). Serum albumin, prealbumin and IgA in the early oral intake group were significantly higher than those in the traditional feeding group on the 7th day after operation (P <0.05). There was no significant difference in Ig G and Ig M between the two groups (P> 0.05). The proportion of tolerable patients in early oral intake group and traditional feeding group was 91.7% (66/72) and 94.0% (63/67), respectively. There was no significant difference between the two groups (χ ~ 2 = 0.044, P = 0.833). Although patients with early oral intake of 2 patients due to nausea, abdominal distension need to reset the stomach, but after 3 days of conservative treatment have been cured. The total complication of early oral intake group and traditional eating group were 10 cases (13.9%) and 11 cases (16.4%), respectively. There was no significant difference in the total complication rates between the two groups (χ ~ 2 = 0.173, P = 0.677). All complications were cured after active treatment were discharged. 102 patients were followed up for a period of 1 to 6 months after operation. No patients were admitted to hospital again due to postoperative complications. Conclusions Early oral laparoscopic radical gastrectomy for patients with gastric cancer is safe and feasible. It can improve the nutritional status and immune function of the patients without any increase of complications, promote the recovery of intestinal function and shorten The postoperative hospital stay.