CAJ | 학술논문

目的探讨围手术期肠内营养支持对顽固性便秘合并继发性巨结肠的外科治疗预后的影响.方法回顾性分析2007年6月至2011年6月在我院接受手术治疗的78例顽固性便秘合并继发性巨结肠患者的临床资料.结果 78例患者均经过胃肠减压和全静脉营养支持治疗,34例患者肠道恢复通畅,再行2周的全肠内营养支持后择期手术(肠内营养组,enteral nutrition组).另外44例无法恢复肠道通畅者,未接受肠内营养支持治疗,直接手术(未接受肠内营养组,non-enteral nutrition组).手术方式包括金陵术(结肠次全切除+升结肠-直肠后壁侧侧吻合术)45例、金陵术+末端回肠保护性造口术6例、结肠全切除+末端回肠与直肠后壁侧侧吻合术18例、结肠全切除+末端回肠临时造口术9例.术前接受肠内营养的患者的并发症发生率(肺炎0％vs 11.4％、吻合口瘘0％vs 11.4％、吻合口出血2.9％ vs 18.2％、手术造口率0％vs 34.1％),均明显低于术前未接受肠内营养支持组的患者,2组比较,差异有统计学意义(P＜0.05).术前接受肠内营养组的患者,术后1个月的机体指标(包括体重、去脂体重、蛋白质含量、细胞内液、细胞外液、体重指数等)的改善优于未接受肠内营养组.结论顽固性便秘合并继发性巨结肠需外科治疗,术前应尽可能恢复肠道功能,行肠内营养支持治疗,可显著降低围手术期并发症发生率.
목적 탐토위수술기장내영양지지대완고성편비합병계발성거결장적외과치료예후적영향.방법 회고성분석2007년6월지2011년6월재아원접수수술치료적78례완고성편비합병계발성거결장환자적림상자료.결과 78례환자균경과위장감압화전정맥영양지지치료,34례환자장도회복통창,재행2주적전장내영양지지후택기수술(장내영양조,enteral nutrition조).령외44례무법회복장도통창자,미접수장내영양지지치료,직접수술(미접수장내영양조,non-enteral nutrition조).수술방식포괄금릉술(결장차전절제+승결장-직장후벽측측문합술)45례、금릉술+말단회장보호성조구술6례、결장전절제+말단회장여직장후벽측측문합술18례、결장전절제+말단회장림시조구술9례.술전접수장내영양적환자적병발증발생솔(폐염0％vs 11.4％、문합구루0％vs 11.4％、문합구출혈2.9％ vs 18.2％、수술조구솔0％vs 34.1％),균명현저우술전미접수장내영양지지조적환자,2조비교,차이유통계학의의(P＜0.05).술전접수장내영양조적환자,술후1개월적궤체지표(포괄체중、거지체중、단백질함량、세포내액、세포외액、체중지수등)적개선우우미접수장내영양조.결론 완고성편비합병계발성거결장수외과치료,술전응진가능회복장도공능,행장내영양지지치료,가현저강저위수술기병발증발생솔.
Objective Refractory constipation,when complicated with megacolon,is difficult to manage.This study aimed to compare the clinical outcomes of different preoperative nutritional therapies on refractory constipation patients complicated with megacolon.Methods Patients of refractory mixed constipation complicated with megacolon receiving surgical interventions between 2006 Jun and 2011 Jun were enrolled.Perioperafive nutrition support was evaluated in terms of postoperative recovery.Results 78 constipation patients received therapies of NPM,gastrointestinal decompression and total parenteral nutrition during the first 7-14 days.34 patients retained intestine patency and after 2 weeks of enteral nutrition therapy,they (enteral nutrition group) successfully received selective surgery.The other 44 patients (non-enteral nutrition group) received emergency surgery after correcting homeostasis.The surgical procedures included Jinling procedure (n =45),Jinling procedure plus ileostomy (n =6),total colectomy plus ileum-rectum side-to-side anastomosis (n =18) and total colectomy plus ileostomy (n =9).EN group patients had a significant low rate of pneumonia (0％ vs 11.4％),anastomotic leakage (0％ vs 11.4％),anastomotic bleeding (2.9％ vs 18.2％) and ostomy (0％ vs 34.1％),compared with N-EN group.At one month follow up,the nutrition status was significantly better in EN group than that in N-EN group.Condusions Refractory constipation complicated with megacolon required surgical intervention.Recovering the intestinal patency and receiving enteral nutritional support therapy preoperatively benefits patient's recovery.