腹腔镜下修补儿童食管裂孔疝术后早期肠内营养结合静脉营养的经验分析-现代医学

腹腔镜下修补儿童食管裂孔疝术后早期肠内营养结合静脉营养的经验分析

单位：南京医科大学附属儿童医院心胸外科, 江苏南京 210008

分类号：R726.1

出版年·卷·期（页码）：2025·53·第二期（264-270）

摘要：

目的：探讨食管裂孔疝修补+抗返流术后早期肠内营养结合静脉营养对患儿术后恢复的影响。方法：回顾性分析2016年10月至2023年5月在南京医科大学附属儿童医院心胸外科行食管裂孔疝修补+抗返流术的患儿73例，依据营养支持方法的不同，设为早期联合营养组32例和全肠外营养组41例。比较两组术前1天和术后第7天的营养状况相关指标、肝功能相关指标、术后并发症及住院时间。结果：早期联合营养组的前白蛋白(PAB)、白蛋白(AB)、总蛋白(TP)大幅度降低，相比全肠外营养组，差异有统计学意义(P＜0.05)；术后第7天检测早期联合营养组的总胆红素(TB)、直接胆红素(DB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)降低，具有统计学意义(P＜0.05)；早期联合营养组的住院天数、并发感染率、胃排空延迟率及高血糖率均低于全肠外营养组(P＜0.05)。早期联合营养组的腹胀腹痛、肠鸣音、胃肠反应等评分均低于全肠外营养组，胃肠道功能的恢复时间明显少于全肠外营养组(P＜0.05)。结论：早期实施肠内联合静脉营养支持对改善儿童食管裂孔疝术后的肝功能、降低相关感染率、缩短胃排空延迟时间以及减少患儿住院天数有很大帮助。

Objective: To investigate the effect of intravenous nutrition combined with early enteral nutrition on postoperative recovery of children with hiatal hernia repair and anti-reflux surgery. Methods: A retrospective analysis was performed on 73 children who underwent hiatal hernia repair+anti-reflux surgery at the Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Nanjing Medical University from October 2016 to May 2023, these patients were divided into an early combined nutrition group of 32 cases and a total parenteral nutrition group of 41 cases. The study compared preoperative day 1 and postoperative day 7 nutritional status indicators, liver function indicators, postoperative complications, and hospital stay between the two groups. Results: The prealbumin(PAB)、albumin(AB)、total protein(TP) in the early combined nutrition group was significantly lower than that in the total parenteral nutrition group, and the difference was statistically significant(P<0.05). On postoperative day 7, the early combined nutrition group demonstrated significant reductions in total bilirubin(TB), direct bilirubin(DB), alanine aminotransferase(ALT), aspartate aminotransferase(AST), and lactate dehydrogenase(LDH) levels compared to preoperative baseline measurements, with all decreases reaching statistical significance(P<0.05). The hospitalization days, co-infection rate, delayed gastric emptying rate and hyperglycemia rate in the early combined nutrition group were lower than those in the total parenteral nutrition group(P<0.05).The gastrointestinal reaction score,abdominal distension pain score and bowel sound score in the early combined nutrition group were lower than those in the total parenteral nutrition group(P<0.05). The scores of abdominal distension and pain, bowel sounds and gastrointestinal reactions in the early combined nutrition group were all lower than those in the total parenteral nutrition group, and the recovery time of gastrointestinal function was significantly shorter than that in the total parenteral nutrition group(P<0.05). Conclusion: Early implementation of enteral combined with intravenous nutrition support is very helpful to improve the recovery of liver function, reduce the related infection rate, shorten the gastric emptying delay time and reduce the length of hospitalization in children after esophageal hiatus hernia surgery.

参考文献：

[1] TRUBA O,ZUCHOWSKA J,GRABCZAK E M,et al.Does hiatal hernia impact gastro-oesophageal reflux-related chronic cough?[J].ERJ Open Research,2023,9(2):00669-2022.
[2] LATZKO M,BORAO F,SQUILLARO A,et al.Laparoscopic repair of paraesophageal hernias[J].JSLS,2014,18(3):e2014.00009.
[3] 胡明,严志龙,蔡金晶,等.腹腔镜手术治疗1岁以内婴儿食管裂孔疝[J].临床小儿外科杂志,2012,11(4):256-259.
[4] ADIAMAH A,RANAT R,GOMEZ D.Enteral versus parenteral nutrition following pancreaticoduodenectomy:a systematic review and meta-analysis[J].HPB (Oxford),2019,21(7):793-801.
[5] 潘军平,吴亚夫,朱新华,等.胰十二指肠切除术后经鼻肠营养管喂养和经空肠造瘘管喂养的疗效及相关并发症[J].中国临床研究,2022,35(3):334-338.
[6] 周玲,姚海霞,颜景灏,等.先天性食管裂孔疝合并贫血围手术期管理策略的对照研究[J].中华胃食管反流病电子杂志,2020,7(4):216-220.
[7] 中华医学会肠外肠内营养学分会,中国医药教育协会加速康复外科专业委员会.加速康复外科围术期营养支持中国专家共识(2019版)[J].中华消化外科杂志,2019,18(10):897-902.
[8] 吴国豪,谈善军.胃肠外科患者围手术期全程营养管理中国专家共识(2021版)[J].中国实用外科杂志,2021,41(10):1111-1125.
[9] WEIMANNA,BRAGA M,CARLI F,et al.ESPEN practical guideline:clinical nutrition in surgery[J].Clin Nutr,2021,40(7):4745-4761.
[10] 张聪,明葛东.加速康复外科理念联合循证护理在儿童围手术期饮食管理中的应用[J].当代护士(中旬刊),2020,27(9):62-64.
[11] MATSUGU Y,ITO K,OSHITA A,et al.Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy:a retrospective study[J].Nutr Clin Pract,2021,37(3):654-655.
[12] LEWIS S R,SCHOFIELD-ROBINSON O J,ALDERSON P,et al.Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit[J].Cochrane Database Syst Rev,2018,6(6):CD012276.
[13] TANAKA M,HECKLER M,MIHAVIC A L,et al.Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy[J].Br J Surg,2019,106(9):1138-1146.
[14] 王伟刚,屈坤鹏,唐晓勇,等.腹腔镜食管裂孔疝修补术不同手术方式的临床疗效及预后分析[J].中华普通外科杂志,2022,37(11):830-833.
[15] 祁海杰,余帅,汪力,等.单中心腹腔镜治疗小儿食管裂孔疝的中远期疗效观察[J].临床外科杂志,2021,29(7):676-678.
[16] HAYAMA S,SENMARU N,HIRANO S.Delayed gastric emptying after pancreatoduodenectomy:comparison between invaginated pancreatogastrostomy and pancreatojejunostomy[J].BMC Surg,2020,20(1):60.
[17] MOON K,MCKINNON E,CROFT K,et al.Early versus late parenteral nutrition in term and late preterm infants:a randomised controlled trial[J].BMJ Paediatrics Open,2024,8(1):e002579.
[18] HE L B,LIU M Y,HE Y,et al.Nutritional status efficacy of early nutritional support in gastrointestinal care:a systematic review and Meta-analysis[J].World J Gastrointest Surg,2023,15(5):953-964.
[19] LI K,WANG D,ZHANG X,et al.Efficacy of early enteral nutrition versus total parenteral nutrition for patients with gastric cancer complicated with diabetes mellitus:a systematic review and Meta-analysis[J].Nutr Diet,2022,79(1):129-139.
[20] MANDAL A,JAJOO M,SINGH A,et al.Early total versus gradually advanced enteral nutrition in stable very-low-birth-weight preterm neonates:a randomized,controlled trial:authors'reply[J].Indian J Pediatr,2022,89(9):950.
[21] BEHERA B K,MISRA S,TRIPATHY B B.Systematic review and Meta-analysis of safety and efficacy of early enteral nutrition as an isolated component of Enhanced Recovery After Surgery[ERAS]in children after bowel anastomosis surgery[J].J Pediatr Surg,2022,57(8):1473-1479.

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