CAJ | 학술논문

目的：探讨先天性长段型食管闭锁Ⅰ期手术术中留置鼻空肠营养管术后早期肠内营养对患儿术后营养状况、病程和转归的影响。方法回顾性分析我院2006年1月至2013年12月收治的先天性长段型食管闭锁患儿的临床资料,选取Ⅰ期手术的病例,根据术中是否留置鼻空肠管分成两组,鼻空肠管喂养(transanastomotic nasointestinal feeding tubes group,TNFT)组为术中留置经过吻合口的鼻空肠管,经口喂养(nonfeeding tube group,NFT)组为术中未留置鼻饲管,统计分析两组病例的一般资料特点、术前状况、术后并发症、围手术期治疗和营养支持等。结果2006年1月至2013年12月我院收治的先天性长段型(盲端距离>2 cm)食管闭锁患儿共37例,排除外院首次手术病例12例,我院首次手术的病例共25例,其中Ⅰ期手术19例,分期手术6例(先行胃造口术,再行食管重建术),术后均明确诊断为长段型食管闭锁。其中,NFT组11例,TNFT组8例。比较两组在胎龄、出生体重、术前体重、术前等待时间、合伴畸形、术前术后并发症、术前机械通气、住院时间、非住ICU时间、术后平均体重增长速度等方面差异均无统计学意义(P>0.05)。而TNFT组患儿术后首次开放肠内营养时间较NFT组缩短(0.8 d vs.9.1 d),完全过渡到全肠内营养时间较NFT组提前(15.9 d vs.21.4 d),术后脱机时间较NFT组延长(23.5 d vs.19.3 d),差异均有统计学意义(P<0.05)。结论长段型食管闭锁术中留置经过吻合口的鼻空肠管,有利于术后早期开放肠内营养,减少静脉营养依赖性,且不增加吻合口漏等并发症,但因病例数有限,还需进一步多中心大样本前瞻性研究加以证实。
목적：탐토선천성장단형식관폐쇄Ⅰ기수술술중류치비공장영양관술후조기장내영양대환인술후영양상황、병정화전귀적영향。방법회고성분석아원2006년1월지2013년12월수치적선천성장단형식관폐쇄환인적림상자료,선취Ⅰ기수술적병례,근거술중시부류치비공장관분성량조,비공장관위양(transanastomotic nasointestinal feeding tubes group,TNFT)조위술중류치경과문합구적비공장관,경구위양(nonfeeding tube group,NFT)조위술중미류치비사관,통계분석량조병례적일반자료특점、술전상황、술후병발증、위수술기치료화영양지지등。결과2006년1월지2013년12월아원수치적선천성장단형(맹단거리>2 cm)식관폐쇄환인공37례,배제외원수차수술병례12례,아원수차수술적병례공25례,기중Ⅰ기수술19례,분기수술6례(선행위조구술,재행식관중건술),술후균명학진단위장단형식관폐쇄。기중,NFT조11례,TNFT조8례。비교량조재태령、출생체중、술전체중、술전등대시간、합반기형、술전술후병발증、술전궤계통기、주원시간、비주ICU시간、술후평균체중증장속도등방면차이균무통계학의의(P>0.05)。이TNFT조환인술후수차개방장내영양시간교NFT조축단(0.8 d vs.9.1 d),완전과도도전장내영양시간교NFT조제전(15.9 d vs.21.4 d),술후탈궤시간교NFT조연장(23.5 d vs.19.3 d),차이균유통계학의의(P<0.05)。결론장단형식관폐쇄술중류치경과문합구적비공장관,유리우술후조기개방장내영양,감소정맥영양의뢰성,차불증가문합구루등병발증,단인병례수유한,환수진일보다중심대양본전첨성연구가이증실。
Objective To assess the benefit of intraoperatively placed nasointestinal feeding tubes for early postoperative enteral nutrition.Methods The retrospective study was carried out on 19 cases of in-fants with long gap esophageal atresia who underwent one-stage operation in Xinhua Hospital from January 2006 to December 2013.Patients were divided into two groups according to whether the transanastomotic na-sointestinal feeding tubes(TNFT)were placed.Demographics,associated anomalies,operative findings,com-plications,duration of enteral nutrition(EN),length of stay were analyzed.Results Thirty-seven patients had long gap esophageal atresia and nineteen underwent one-stage operation.Eight patients were identified as TNFT group while eleven patients were identified as nonfeeding tube(NFT)group.There was no significant differences between the two groups in gestational age,birth weight,associated anomalies,anastomotic leak, weight gain,ICU-free days and length of stay(P>0.05).But the ventilator-free days(23.5 d vs.19.3 d), first EN time(0.8 d vs.9.1 d)and total EN feeding time(15.9 d vs.21.4 d)between the two groups were significantly different(P<0.05 ).Conclusion Intraoperatively placed TNFT may lead to earlier EN feeding and shorter parenteral nutrition duration,but a larger prospective study would be required to prove the benefits and ensure the safety.