Benefits Versus Risks: A Prospective Audit Feeding Jejunostomy During Esophagectomy
Benefits Versus Risks: A Prospective Audit Feeding Jejunostomy During Esophagectomy
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DOI：
10.1007/s00268-009-0019-1
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发表时间：
2009-07-01
影响因子：
2.6
通讯作者：
Gupta, Vikas
中科院分区：
文献类型：
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作者：
Gupta, Vikas
本前瞻性数据库的目的是评价术后空肠造口喂养的安全性、有效性和实用性，以达到食管切除术患者的营养目标，并评价胃肠道和机械并发症。本研究包括204例因各种良性和恶性疾病接受食管切除术的连续患者。所有患者在剖腹手术时均接受Witzel喂养空肠吻合术。对患者进行前瞻性随访，记录营养摄入、饲料类型、速率进展、耐受性和机械或胃肠道并发症，99.5%的患者可进行空肠吻合术，6.0%的患者在喂养过程中导管堵塞。78%的患者在第三天可以达到目标热量需求。总的来说，95%的患者可以在术后期间成功地完全通过空肠造口导管喂养。15%的患者出现轻微胃肠道并发症，通过减慢输注速率或给药进行管理。术后患者平均花费16.67 +/- A 22.00天（范围0-46天）进行空肠造口喂养;然而，13%的患者需要延长空肠造口喂养超过30天。总的来说，64%的吻合口瘘患者和50%的术后并发症患者需要导管空肠造口喂养超过30天。发生吻合口破裂的患者使用空肠造口管喂养的平均持续时间明显更长（33.05 +/- A 16.24 vs. 14.69 +/- A 19.04天; p = 0.000）和术后并发症（26.67 +/- A 25.56 vs. 14.52 +/- A 18.64天; p = 0.000）。没有与需要再次介入的营养导管相关的严重并发症。发生并发症或吻合口破裂的患者与其对应患者相比，10天结束时和1个月时的平均体重或体重不足无差异。无一例患者死于与空肠造口喂养相关的并发症。空肠造口管喂养是为食管切除术患者提供营养支持的一种有效方法，它可以为无法茁壮成长的患者提供家庭支持。发生吻合口破裂和术后并发症的患者继续延长管饲。营养空肠吻合术在食管切除术后的管理中具有决定性的作用。
The purpose of this prospectively collected database is to evaluate the safety, efficacy, and utility of postoperative jejunostomy feeding in terms of achieving nutritional goals and evaluating gastrointestinal and mechanical complications in patients undergoing esophagectomy.The study included 204 consecutive patients who underwent esophagectomy for various benign and malignant conditions. All patients underwent Witzel feeding jejunostomy at the time of laparotomy. Patients were followed prospectively to record nutritional intake, type of feed administered, rate progression, tolerance, and complications either mechanical or gastrointestinal.Feeding jejunostomy could be performed in 99.5% patients; 6.0% of the patients had a blocked catheter during the course of feeding. The target calorie requirement could be achieved in 78% of patients by third day. In all, 95% of patients could be successfully fed exclusively by jejunostomy catheter during the postoperative period. Minor gastrointestinal complications developed in 15% of the patients and were managed by slowing the rate of infusion or administering medication. Patients spent a mean of 16.67 +/- A 22.00 days (range 0-46 days) on jejunostomy feeding after surgery; however, 13% required prolonged jejunostomy feeding beyond 30 days. Altogether, 64% of the patients with an anastomotic leak and 50% of the patients with postoperative complications required catheter jejunostomy feeding beyond 30 days. The mean duration for which jejunostomy tube feeding was used was significantly higher for patients who developed anastomotic disruptions (33.05 +/- A 16.24 vs. 14.69 +/- A 19.04 days; p = 0.000) and postoperative complications (26.67 +/- A 25.56 vs. 14.52 +/- A 18.64 days; p = 0.000) when compared to those without disruption or complications. There were no serious complications related to the feeding catheter that required reintervention. There was no difference in the mean body weight or weight deficit at the end of 10 days and at 1 month in patients who developed complications or anastomotic disruption when compared to their counterparts. No patient died as a result of a complication related to the feeding jejunostomy.Tube jejunostomy feeding is an effective method for providing nutritional support in patients undergoing esophagectomy, and it allows home support for the subset who fail to thrive. Prolonged tube feeding was continued in patients developing anastomotic disruptions and postoperative complications. Feeding jejunostomy has a definitive role to play in the management of the patients undergoing esophagectomy.