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題名 | Nutritional Support for Hypopharyngeal Cancer Patients: Nasoduodenal Tube Feeding or Total Parenteral Nutrition, Which Is Better?=比較鼻-十二指腸管營養供給及全靜脈營養於下咽癌病人營養補給,何者較佳? |
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作者 | 吳政君; 陳彥州; 蔡昀達; 楊景翔; 郭寶仁; 蔡岳儒; 周業彬; 吳紹群; 謝青華; 楊家森; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 23:2 2014.06[民103.06] |
頁次 | 頁117-125 |
分類號 | 416.351 |
關鍵詞 | 鼻-十二指腸管; 腸道營養; 全靜脈營養; 下咽癌; Hypopharyngeal cancer; Nasoduodenal nutrition; Total parenteral nutrition; |
語文 | 英文(English) |
中文摘要 | 背景:良好的營養在傷口癒合扮演重要的角色。營養不良是下咽癌病人常見的問題,主要是因為晚期診斷及吞嚥困難。術前的營養支持效果通常不佳,病人常因擔心腹部併發症不願接受胃造廔或空腸造廔。全靜脈營養在本院被常規地使用在術後下咽癌病人。我們因擔心胃食道逆流及嘔吐而不使用鼻胃管。然而,文獻中關於腸道營養及全靜脈營養的比較仍然存在著許多爭議。目的及目標:在下咽癌術後的病人,比較使用鼻-十二指腸管作為腸道營養及全靜脈營養的效果,何者較佳。材料及方法:從2010年1月到2011年4月,高雄長庚醫院整形外科收治了386位頭頸癌的病人,其中有19位以男性為主的下咽癌病人,平均年紀為45.6歲。所有的病人都接受腫瘤切除及自由皮瓣重建。前9位病人接受全靜脈營養,作為對照組。後10位病人為實驗組,接受鼻-十二指腸腸道營養,鼻-十二指腸管於手術室皮瓣重建前由腸胃科醫師放置。我們記錄術前及術後第一,第三,第七天的營養指標,包括albumin,prealbumin,triglyceride,transferrin。我們比較這兩組病人在第一,第三及第七天的實驗數據與術前的差異,並使用student t test來比較是否有統計上的意義。結果:所有病人恢復良好,雖然有幾位病人因輕度感染及血腫需要二次手術。在比較鼻-十二指腸腸道營養及全靜脈營養這兩組病人術後的營養指標,結果並無統計學上的意義。(P > 0.05)結論:鼻-十二指腸管所提供的腸道營養及全靜脈營養都能在短期內為下咽癌病人術後提供相同的營養。然而鼻-十二指腸管所提供的腸道營養的花費較低,且術中所花費的時間也是在可接受的範圍內。 |
英文摘要 | Background: Morbidities such as poor wound healing and delayed recovery from illness are common in patients with poor nutritional status. Hypopharyngeal cancer patients are prone to poor nutrition, mainly due to late diagnosis and swallowing difficulties. Preoperative nutritional support is not feasible since these patients are reluctant to receive preoperative gastrostomy or jejunostomy to improve their nutritional status, mainly due to the fear of additional abdominal surgery, unless total esophageal obstruction has been encountered. Total parenteral nutrition (TPN) was routinely used in our institute for postoperative nutritional support after hypopharyngeal cancer ablation and reconstruction. Nasogastric (NG) tube feeding was abandoned due to the fear of reflux/vomiting. However, enteral nutrition should yield more superior results as compared to TPN based on published literatures. Aim and Objectives: To determine whether enteral feeding through a nasoduodenal (ND) tube can enhance better postoperative nutritional support as compared to TPN for hypopharyngeal cancer patients. Materials and Methods: From Jan 2010 to April 2011, a total of 386 head and neck reconstructions were performed in Kaohsiung Chang Gung Memorial Hospital, Taiwan. A total of nineteen consecutive hypopharyngeal cancer male patients were collected, age 39~69, averaging 45.6 years old. All patients received cancer ablation and free flap reconstruction. The first nine consecutive patients (TPN group) were used as control, and received postoperative TPN; ten patients (ND group) received intraoperative endoscopic ND tube placement immediately after tumor ablation, before free flap reconstruction. Laboratory tests for albumin, prealbumin, triglyceride, and transferrin were performed preoperatively, and on postoperative day (POD) 1, 3, and 7, and absolute changes were calculated relative to preoperative levels. Changes in these laboratory parameters in TPN and ND groups were then compared using student-t tests. Results: Nineteen patients were included in the study (9 patients in the TPN group and 10 patients in the ND group). All flaps survived and the patients have recovered well. Minor infections and one hematoma were treated with secondary surgical intervention. No statistical significant changes in nutritional parameter were found between TPN and ND groups (p > 0.05). Conclusion: Both the ND feeding and TPN yield comparable short-term postoperative nutritional support. However, ND can provide nutritional support at a lower cost, with acceptable intraoperative delay for its placement. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。