CAJ | 학술논문

目的研究家庭肠内营养(HEN)对晚期胃癌患者改善生活质量的意义.方法回顾性分析浙江省人民医院胃肠外科2010年6月1日至2012年6月1日连续收治的60例无法手术切除及复发转移的晚期胃癌患者的病历资料,根据是否进行HEN分为肠内营养(EN)组(25例)和对照组(35例).EN组营养支持方式包括经空肠造瘘管EN、经鼻胃肠管完全或部分EN;对照组中存在胃癌伴梗阻的患者进行全肠外营养(TPN),其余患者完全经口饮食.在持续1年的随访过程中,分别于第1、3、6和12月进行Karnofsky评分和Spitzer指数测定,第6月时行EORTC QLQ-C30评分.全组患者均接受FLOFOX4方案(奥沙利铂、四氢叶酸钙、氟尿嘧啶)静脉化疗.结果两组患者在基线资料方面差异无统计学意义.1年随访期间,两组共有53例患者死亡,其中EN组21例,对照组32例.Karnofsky评分结果显示,EN组在第3、6、12月的评分结果分别为平均57.4、39.6和28.2,明显优于对照组的平均45.3、29.2和20.1(分别为P=0.041、P=0.012和P=0.015).Spitzer评分结果显示,EN组在第3、6、12月的评分结果分别为5.12、4.04和2.54,也明显优于对照组的4.32、3.21和1.97(分别为P=0.048、P=0.035和P=0.024).EROTC QLQ-30评分结果显示,EN组在功能量表方面同样均明显优于对照组(均P＜0.05),“呼吸费力”、“疼痛”和“疲劳”阳性症状较对照组轻(分别为P＝0.025、P=0.044和P=0.016)；但“腹泻”症状较对照组明显(P=0.047).结论 HEN作为一项营养干预措施,能在有限的生存期内改善晚期胃癌患者的生活质量.
목적 연구가정장내영양(HEN)대만기위암환자개선생활질량적의의.방법 회고성분석절강성인민의원위장외과2010년6월1일지2012년6월1일련속수치적60례무법수술절제급복발전이적만기위암환자적병력자료,근거시부진행HEN분위장내영양(EN)조(25례)화대조조(35례).EN조영양지지방식포괄경공장조루관EN、경비위장관완전혹부분EN;대조조중존재위암반경조적환자진행전장외영양(TPN),기여환자완전경구음식.재지속1년적수방과정중,분별우제1、3、6화12월진행Karnofsky평분화Spitzer지수측정,제6월시행EORTC QLQ-C30평분.전조환자균접수FLOFOX4방안(오사리박、사경협산개、불뇨밀정)정맥화료.결과 량조환자재기선자료방면차이무통계학의의.1년수방기간,량조공유53례환자사망,기중EN조21례,대조조32례.Karnofsky평분결과현시,EN조재제3、6、12월적평분결과분별위평균57.4、39.6화28.2,명현우우대조조적평균45.3、29.2화20.1(분별위P=0.041、P=0.012화P=0.015).Spitzer평분결과현시,EN조재제3、6、12월적평분결과분별위5.12、4.04화2.54,야명현우우대조조적4.32、3.21화1.97(분별위P=0.048、P=0.035화P=0.024).EROTC QLQ-30평분결과현시,EN조재공능량표방면동양균명현우우대조조(균P＜0.05),“호흡비력”、“동통”화“피로”양성증상교대조조경(분별위P＝0.025、P=0.044화P=0.016)；단“복사”증상교대조조명현(P=0.047).결론 HEN작위일항영양간예조시,능재유한적생존기내개선만기위암환자적생활질량.
Objective To investigate the application of home enteral nutrition(HEN) in patients with advanced gastric cancer and its impact on the quality of life.Methods Data of 60 consecutive patients with advanced gastric cancer,who could not underwent operation and had relapse metastasis,from June 2010 to June 2012 were retrospectively analyzed.According to familial nutritional pattern,these 60 patients were divided into HEN group(25 cases) receiving home enteral nutritional support and control group (35 cases).HEN patients were supported through jejunostomy tube or nasal gastric tube.Control patients were supported through total parental nutrition or purely eating respectively.All the patients received intravenous chemotherapy and evaluated by Kamofsky index and Spitzer system in the first,third,sixth and twelfth month.In the sixth month,patients were also examined by EORTC QLQ-C30.Results No significant differences were found between the two groups according to 8 elements containing age,sex,BMI,etc.A total of 53 patients died within one year,including 21 in HEN group and 32 in control group.The Karnofsky scales showed that HEN group scored meanly 57.4,39.6 and 28.2 in the third,sixth and twelfth month respectively,which were significantly higher than those of control group (45.3,29.2 and 20.1,P=0.041,P=0.012 and P=0.015 respectively).The Spitzer scales showed that HEN group scored meanly 5.12,4.04 and 2.54 on average in the third,sixth and twelfth month respectively,which were significantly higher than those of control group (4.32,3.01 and 1.97,P=0.048,0.035 and P=0.024 respectively).The EROTC QLQ-C30 scales showed that HEN group scored higher than control group in functional scales (P＜0.05),and lower in the symptom scales of short breathing,pain and tired (P=0.025,P=0.044,P=0.036 respectively),while higher in diarrhea(P=0.047).Conclusions The quality of life of patients with advanced gastric cancer declines gradually with the nutritional status deteriorating.HEN can be applied to improve the nutritional status and quality of life.