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目的：探讨术前合理的营养支持对胃癌及结直肠癌患者术后恢复的影响．方法：消化道恶性肿瘤手术并存在营养不良的患者69例,分为肠外营养组(PN组,24例)、肠内肠外营养结合组(EN-PN组,23例)和常规治疗组(NN组,22例),PN组和EN-PN组均于术前7d开始营养治疗,3组患者均于术后24 h开始肠内和肠外相结合的营养方式．分别于术前7d和术后7d测定血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)、血清内毒素水平及细胞因子IL-6、TNFα,测定血清IgA,IgG,IgM,NK细胞活性及CD4/CD8值评价免疫功能,比较3组患者并发症的发生率及平均住院时间．结果：EN-PN组在术后7 d血清内毒素水平(4．23±2．01 ng/L)、IL-6(40．22±7．43 ng/L)及TNF-α(33．04±4．56 ng/L)均明显低于PN(分别为8．23±3．65,55．21±9．32,47．22±8．45 ng/L,P＜0．01)和NN组(10．66±5．23,67．01±10．21,56．43±9．67,ng/L P＜0．01)．而EN-PN组在术后7 d PA(0．27±0．06 g/L),TFN(2．81±0．65 g/L),IgG(10．43±0．86 g/L),NK细胞活性(18．04%±4．56%)及CD4/CD8值(4．98±1．21)明显高于PN组(分别为0．19±0．04,2．01±0．32,8．76±0．65 g/L,11．01%±3．01%,2．11±0．65,P＜0．05)和NN组(分别为0．15±0．03,1．32±0．27,9．05±0．79 g/L,6．45%±2．23%,1．22±0．79,P＜0．05)．与PN和NN组相比,患者并发症发生率(11．3% vs 16．4%,21．6%)和住院时间(7．0±1．4d vs 11．0±2．4,13．0±2．8 d)EN-PN组亦明显降低(P＜0．01)．结论：存在营养不良的消化道恶性肿瘤患者术前应用肠内和肠外营养相结合的营养方式是安全有效的,可促进患者恢复．
Objective: To explore the effect of preoperative nutritional support on postoperative recovery of gastric cancer and colorectal cancer. Methods: 69 patients with malnutrition and surgery in digestive tract malignancy were divided into parenteral nutrition group (PN group, 24 cases), enteral parenteral nutrition combined group (EN-PN group, 23 cases) and routine treatment group. (NN group, 22 cases), PN group and EN-PN group began nutrition therapy 7 days before surgery, 3 groups of patients began 24 hours after the operation of enteral and parenteral nutrition combined mode. Serum albumin (ALB), prealbumin (PA), transferrin (TFN), serum endotoxin levels and cytokines IL-6, TNFα were determined 7 days before and 7 days after surgery to determine serum IgA, IgG, IgM, NK cell activity and CD4/CD8 values were used to evaluate immune function. The incidence of complications and average length of stay were compared among the three groups. RESULTS: In EN-PN group, serum endotoxin levels (4.23±2.01 ng/L), IL-6 (40.22±7.43 ng/L), and TNF-α were detected at 7 days after operation (33. 04±4.56 ng/L) were significantly lower than PN (8.23±3.65, 55.21±9.32, 47.22±8.45 ng/L, P<0.01, respectively) And NN group (10.66±5.23, 67.01±10.21, 56.43±9.67, ng/LP<0.01). In the EN-PN group, PA (0.27±0.06 g/L), TFN (2.81±0.65 g/L), and IgG (10.43±0.86 g/L) were detected 7 days after surgery. ), NK cell activity (18.04% ± 4.56%) and CD4/CD8 value (4.98 ± 1.21) were significantly higher than PN group (0.19 ± 0.04, 2.01 ± 0.32,8.76±0.65 g/L,11.01%±3.01%,2.11±0.65,P<0.05) and NN groups (0.15±0 respectively) .03,1.32±0.27,9.05±0.79 g/L,6.45%±2.23%,1.22±0.79,P<0.05). Incidence of complications in patients (11.3% vs 16.4%, 21.6%) and hospital stay (7.0±1.4d vs 11.0±2.4, 13 vs. PN and NN groups. (0 ± 2.8 d) EN-PN group also significantly reduced (P <0.01). Conclusion: The preoperative nutrition combined with enteral nutrition and parenteral nutrition in malnutrition patients with digestive tract cancer is safe and effective, and can promote recovery.