Clinical Effect of Enteral Nutrition Therapy Via Nasal-Jejunum Tube and Stoma of Jejunum after Whipple Procedure_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JIAShi-feng ¹ , YANFeng ¹ , ZHUHong-cheng ¹ , JIAOGui-mei ¹ , LIUBo ²

1. Department of Surgical Oncology, Affiliated Hospital of Hebei United University, Tangshan 063100, Hebei Province, China;
2. Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100039, China;

Corresponding author：

JIAShi-feng, Email: jsfmmjsf@163.com

Keywords：

Whipple procedure; Jejunum stoma; Enteral nutrition

DOI：

10.7507/1007-9424.20140240

Video：

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Objective To compare the clinical effects of enteral nutrition via stoma of jejunum or nasal-jejunum tube after Whipple procedure. Methods Eighty-seven patients performed Whipple procedure were divided into nasaljejunum tube group(n=47)and stoma of jejunum group(n=40)according to the different enteral nutrition methods. The adverse reactions such as vomiting, abdominal distension, pharyngeal pain, and hypostatic pneumonia, anastomotic leakage, hospital stay, hospitalization expenses, and serum glucose and electrolyte(CL^-, Na⁺, K⁺)on day 1, 3, 5 after operation were compared between two groups. Results Compared with the nasal-jejunum tube group, the rates of adverse reactions and hypostatic pneumonia were more lower(P < 0.05), the hospitalization expense was more less (P < 0.05) in the nasal-jejunum tube group. The rate of anastomotic leakage and hospital stay had no significant differences between the nasal-jejunum tube group and stoma of jejunum group(P > 0.05). The differences of serum glucose and electrolyte(CL^-, Na⁺, K⁺)on day 1, 3, 5 after operation were not statistically significant between two groups(P > 0.05). Conclusions Enteral nutrition via the stoma of jejunum after Whipple procedure has some better clinical effects in reducing adverse reactions such as vomiting, abdominal distension, pharyngeal pain, hypostatic pneumonia. The hospitalization expenses are decreased. There are no obvious effects on the hospital stay, blood glucose and electrolyte concentration on day 1, 3, 5 after operation.

Citation： JIAShi-feng, YANFeng, ZHUHong-cheng, JIAOGui-mei, LIUBo. Clinical Effect of Enteral Nutrition Therapy Via Nasal-Jejunum Tube and Stoma of Jejunum after Whipple Procedure. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 1001-1004. doi: 10.7507/1007-9424.20140240 Copy

1.	游华, 梁峰, 刘莎莎, 等.早期肠内营养对胃大部切除术后患者营养状态、肝功能及并发症的影响[J].山东医药, 2010, 50(20): 79-80.
2.	赵海平, 胡文秀, 吕飞飞, 等.胰腺十二指肠切除术中不同胰肠吻合术式对围手术期并发症的影响[J].中国普外基础与临床杂志, 2013, 20(7): 713-718.
3.	薛秀娟, 孙欣, 张小术, 等.胃肠道肿瘤患者围手术期肠内营养支持的临床研究[J].实用临床医药杂志, 2007, 3(3): 1-2, 4.
4.	Zopf Y, Rabe C, Bruckmoser T, et al. Percutaneous endoscopic jejunostomy and jejunal extension tube through percutaneous endoscopic gastrostomy: a retrospective analysis of success, complications and outcome[J]. Digestion, 2009, 79(2): 92-97.
5.	Zschau N, Nguyen N, Tam W, et al. Intestinal perforation: a rare complication of percutaneous endoscopic jejunostomy removal[J]. Endoscopy, 2008, 40 Suppl 2: E178.
6.	史赢, 陈金明, 孟凡宇.胰十二指肠切除术后经空肠营养管行自制膳食肠内营养支持的临床研究[J].临床外科杂志, 2011, 19(1): 30-32.
7.	Kuwabara Y, Takeyama H. Nutritional support to prevent infectious complication after surgery[J]. Nippon Geka Gakkai Zasshi, 2010, 111(6): 348-352.
8.	Wang X, Pan L, Zhang P, et al. Enteral nutrition improves clinical outcome and shortens hospital stay after cancer surgery[J]. J Invest Surg, 2010, 23(6): 309-313.
9.	Gunerhan Y, Koksal N, Sahin UY, et al. Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters[J]. World J Gastroenterol, 2009, 15(4): 467-472.
10.	袁琮韡, 李俊生, 嵇振岭, 等.全肠外营养及早期肠内营养在胃癌全胃切除术后患者中的对比研究[J].中国普外基础与临床杂志, 2010, 17(4): 357-362.
11.	臧宝华.完全胃肠外营养的临床应用与护理研究进展[J].实用临床医药杂志, 2007, 3(6): 6-9.
12.	宋康颉, 昝建宝, 汪大田, 等.全胃切除术后早期肠内肠外营养的对比研究[J].安徽卫生职业技术学院学报, 2009, 8(1): 33-34, 44.
13.	Szczepanik AM, Scisło L, Walewska E, et al. The effect of immunomodulating enteral nutrition on postoperative cytokine profile in gastric cancer patients[J]. Pol Merkur Lekarski, 2010, 29(172): 235-240.
14.	石悦, 张佳林, 葛春林, 等.胰十二指肠切除术后不同营养支持方式营养疗效的临床分析[J].辽宁医学杂志, 2013, 27(4): 166-170.
15.	赵玉洲, 韩广森, 马鹏飞, 等.胰十二指肠切除术中经胃造口管放置空肠营养管的临床研究[J].肠外与肠内营养, 2012, 19(1): 12-15.
16.	Ogawa T, Oodaira H, Suzuki Y, et al. Successive application of percutaneous endoscopic gastrostomy with jejunal extension and percutaneous endoscopic jejunostomy in a case of multiple system atrophy[J]. Rinsho Shinkeigaku, 2009, 49(6): 370-373.
17.	Moran GW, Fisher NC. Direct percutaneous endoscopic jejunostomy: high completion rates with selective use of a long drainage access needle[J]. Diagn Ther Endosc, 2009, 2009, Article ID 520879. http://dx.doi.org/10.1155/2009/520879..
18.	高明, 强荣.全胃切除术患者经空肠造口与留置鼻空肠营养管行肠内营养比较分析响[J].中国医师进修杂志, 2012, 35(17): 37-39.
19.	冯源, 吴楠, 陈晋峰, 等.术中经皮穿刺空肠营养管或经鼻空肠营养管置入对食管癌患者围手术期营养支持的影响[J].中华临床营养杂志, 2013, 21(1): 8-12.
20.	席鹏程, 时开网, 杨坤兴.胰管内径对胰十二指肠切除术后胰瘘发生率的影响[J].中国普外基础与临床杂志, 2009, 16(8): 609-612.
21.	刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[J].中国普外基础与临床杂志, 2008, 15(3): 195-200.
22.	Rayar M, Sulpice L, Meunier B, et al. Enteral nutrition reduces delayed gastric emptying after standard pancreaticoduodenectomy with child Reconstruction[J]. J Gastrointest Surg, 2012, 16(5): 1004-1011.
23.	吕飞飞, 赵海平.胰十二指肠切除术的早期并发症及危险因素分析(附71例报告)[J].中国普外基础与临床杂志, 2008, 15(3): 205-206.

1. 游华, 梁峰, 刘莎莎, 等.早期肠内营养对胃大部切除术后患者营养状态、肝功能及并发症的影响[J].山东医药, 2010, 50(20): 79-80.
2. 赵海平, 胡文秀, 吕飞飞, 等.胰腺十二指肠切除术中不同胰肠吻合术式对围手术期并发症的影响[J].中国普外基础与临床杂志, 2013, 20(7): 713-718.
3. 薛秀娟, 孙欣, 张小术, 等.胃肠道肿瘤患者围手术期肠内营养支持的临床研究[J].实用临床医药杂志, 2007, 3(3): 1-2, 4.
4. Zopf Y, Rabe C, Bruckmoser T, et al. Percutaneous endoscopic jejunostomy and jejunal extension tube through percutaneous endoscopic gastrostomy: a retrospective analysis of success, complications and outcome[J]. Digestion, 2009, 79(2): 92-97.
5. Zschau N, Nguyen N, Tam W, et al. Intestinal perforation: a rare complication of percutaneous endoscopic jejunostomy removal[J]. Endoscopy, 2008, 40 Suppl 2: E178.
6. 史赢, 陈金明, 孟凡宇.胰十二指肠切除术后经空肠营养管行自制膳食肠内营养支持的临床研究[J].临床外科杂志, 2011, 19(1): 30-32.
7. Kuwabara Y, Takeyama H. Nutritional support to prevent infectious complication after surgery[J]. Nippon Geka Gakkai Zasshi, 2010, 111(6): 348-352.
8. Wang X, Pan L, Zhang P, et al. Enteral nutrition improves clinical outcome and shortens hospital stay after cancer surgery[J]. J Invest Surg, 2010, 23(6): 309-313.
9. Gunerhan Y, Koksal N, Sahin UY, et al. Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters[J]. World J Gastroenterol, 2009, 15(4): 467-472.
10. 袁琮韡, 李俊生, 嵇振岭, 等.全肠外营养及早期肠内营养在胃癌全胃切除术后患者中的对比研究[J].中国普外基础与临床杂志, 2010, 17(4): 357-362.
11. 臧宝华.完全胃肠外营养的临床应用与护理研究进展[J].实用临床医药杂志, 2007, 3(6): 6-9.
12. 宋康颉, 昝建宝, 汪大田, 等.全胃切除术后早期肠内肠外营养的对比研究[J].安徽卫生职业技术学院学报, 2009, 8(1): 33-34, 44.
13. Szczepanik AM, Scisło L, Walewska E, et al. The effect of immunomodulating enteral nutrition on postoperative cytokine profile in gastric cancer patients[J]. Pol Merkur Lekarski, 2010, 29(172): 235-240.
14. 石悦, 张佳林, 葛春林, 等.胰十二指肠切除术后不同营养支持方式营养疗效的临床分析[J].辽宁医学杂志, 2013, 27(4): 166-170.
15. 赵玉洲, 韩广森, 马鹏飞, 等.胰十二指肠切除术中经胃造口管放置空肠营养管的临床研究[J].肠外与肠内营养, 2012, 19(1): 12-15.
16. Ogawa T, Oodaira H, Suzuki Y, et al. Successive application of percutaneous endoscopic gastrostomy with jejunal extension and percutaneous endoscopic jejunostomy in a case of multiple system atrophy[J]. Rinsho Shinkeigaku, 2009, 49(6): 370-373.
17. Moran GW, Fisher NC. Direct percutaneous endoscopic jejunostomy: high completion rates with selective use of a long drainage access needle[J]. Diagn Ther Endosc, 2009, 2009, Article ID 520879. http://dx.doi.org/10.1155/2009/520879..
18. 高明, 强荣.全胃切除术患者经空肠造口与留置鼻空肠营养管行肠内营养比较分析响[J].中国医师进修杂志, 2012, 35(17): 37-39.
19. 冯源, 吴楠, 陈晋峰, 等.术中经皮穿刺空肠营养管或经鼻空肠营养管置入对食管癌患者围手术期营养支持的影响[J].中华临床营养杂志, 2013, 21(1): 8-12.
20. 席鹏程, 时开网, 杨坤兴.胰管内径对胰十二指肠切除术后胰瘘发生率的影响[J].中国普外基础与临床杂志, 2009, 16(8): 609-612.
21. 刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[J].中国普外基础与临床杂志, 2008, 15(3): 195-200.
22. Rayar M, Sulpice L, Meunier B, et al. Enteral nutrition reduces delayed gastric emptying after standard pancreaticoduodenectomy with child Reconstruction[J]. J Gastrointest Surg, 2012, 16(5): 1004-1011.
23. 吕飞飞, 赵海平.胰十二指肠切除术的早期并发症及危险因素分析(附71例报告)[J].中国普外基础与临床杂志, 2008, 15(3): 205-206.

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Clinical Effect of Enteral Nutrition Therapy Via Nasal-Jejunum Tube and Stoma of Jejunum after Whipple Procedure

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