Objective:To investigate the effects of enteral nutrition assisted therapy in preventing postoperative anastomotic fistula in patients with esophageal cancer and its influence on immunity,healing process and nutritional recovery.Methods: The clinical data of 90 cases of patients with esophageal cancer who underwent surgical treatment were retrospectively analyzed.According to the mode of postoperative nutritional support,the patients were divided into group A(n=34),B(n=30)and C(n=26)three groups.Group A was treated by immune-enhancing enteral nutrition(Supportan)assisted therapy.Group B was treated with routine enternal nutrition(Nutrison Fibre)assisted therapy.Both of the two groups were treated with 25%,50% and 100% of the full dose on the 1st,2nd and 3rd-7th day after surgery.Later,the dose was reduced day by day till normal diet.Group C was treated by parenteral nutrition assisted therapy.Since the 1st day after surgery,patients in group C were intravenously injected with glucose,vita min and a mino acid mixed liquid calculated by 125.52 kJ/kg.8-10 d later,patients gradually transited to the normal diet.The incidence rates of anastomotic fistula,pulmonary infection and incision infection,wound healing time,total hospitalization time and initial exhaust time were observed and compared between the three groups.The changes of immune index [T lymphocytes and its subsets(CD3+,CD4+,CD8+)],inflammatory factors[C reactive protein(CRP),IL-6]and nutrition indexes[serum total protein(TP),albumin(ALB)]before surgery,on the 1st and 8th day after surgery were recorded.Results: ①There were significant differences in the incidence rates of postoperative anastomotic fistula and pulmonary infection between the three groups(P<0.05),and the incidence rates in group C were significantly higher than those in the other two groups(P<0.05).②There were significant differences in wound healing time,total hospitalization time and initial exhaust time between the three groups(P<0.05)and that of group C group was longer than that of the other two groups(P<0.05).③On the 1st day after surgery,the levels of immune indexes such as CD3+,CD4+,CD4+/CD8+ and nutrition indexes such as TP and ALB in the three groups were significantly lower than those before surgery.CD8+ levels and levels of inflammatory indexes such as CRP and IL-6 were significantly higher than those before surgery(P<0.05).However,there was no significant difference between the groups(P>0.05).On the 8th day after surgery,the nutrition indexes in the three groups were still significantly lower than those before surgery.However,those in group A and B were significantly higher than those in group C(P<0.05);the inflammatory factors were still significantly higher than those before surgery(P<0.05)but those in group A and B were significantly lower than those in group C(P<0.05).Among the three groups,there was no statistical significance in comparing the immune indexes with those in group A(P>0.05).The levels of CD3+,CD4+,CD4+/CD8+ in the other two groups were lower than those before surgery while CD8+ level was higher than that before surgery(P<0.05).Conclusion: To apply enteral nutrition assisted therapy in patients with esophageal cancer after surgery can effectively improve the prognosis.It has positive effects on shortening the healing process,improving the immune function and improving the nutritional status.%目的:探讨肠内营养辅助治疗对食管癌患者术后吻合口瘘的预防效果及对患者免疫功能、愈合进程及营养恢复的影响.方法:回顾性分析90例行手术治疗的食管癌患者临床资料,根据其术后营养辅助治疗方式分为A(n=34)、B(n=30)、C(n=26)三组.A组接受免疫增强型肠内营养(瑞能)辅助治疗方案,B组采用常规肠内营养(能全力)辅助治疗方案,两组均于术后第1天、第2天及第3~7天给予全量的25%、50%和100%后,逐日减少剂量直至过渡到正常饮食;C组接受肠外营养辅助治疗方案,术后第1天起静脉输注葡萄糖、维生素、氨基酸等混合液,以125.52 kJ/kg计算,应用8~10 d后逐渐过渡至正常饮食.观察对比三组受试者术后吻合口瘘、肺部感染、切口感染发生率及创口愈合时间、总住院时间、首次排气时间差异,记录其术前及术后第1、8天时免疫指标[T淋巴细胞及其亚群(CD3+、CD4+、CD8+)]、炎症因子[C反应蛋白(CRP)、IL-6]、营养指标[血清总蛋白(TP)、清蛋白(ALB)]变化情况.结果:①三组术后吻合口瘘及肺部感染发生率对比差异有统计学意义(P<0.05),且C组发生率显著高于其他两组(P<0.05).②三组创口愈合时间、总住院时间及首次排气时间对比均有统计学意义(P<0.05),且C组均长于其他两组(P<0.05).③术后第1天,三组患者CD3+、CD4+、CD4+/CD8+等免疫指标水平及TP、ALB等营养指标水平均较术前显著降低,CD8+水平及CRP、IL-6等炎症因子水平则较术前显著提升(P<0.05),但组间对比无统计学意义(P>0.05).术后第8天,三组各营养指标仍明显低于术前,但A、B组显著高于C组(P<0.05);各炎症因子指标仍显著高于术前(P<0.05),但A、B组显著低于C组(P<0.05).三组中A组术后第8天各免疫指标与术前比较无统计学意义(P>0.05),其余两组患者CD3+、CD4+、CD4+/CD8+水平均较术前降低,CD8+水平则明显提升(P<0.05).结论:食管癌患者术后予以肠内营养辅助治疗方案,能有效改善其预后质量,对缩短愈合进程、提升机体免疫功能、改善营养状态等具有积极影响.
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