Comparison of the Influence of Enteral Nutrition and Total Parenteral Nutrition on Liver, Kidney and Gastrointestinal Function in Patients after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUShuai ¹ ,  WANGZhi-gang ¹ , HUANGMin-qian ¹ , LINLi-yao ¹ , XIEJian-long ¹ , BAIPei-ru ²

1. Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001, Guangdong, P. R. China;
2. Department of Cardiac Surgery, Gaozhou People's Hospital, Gaozhou 525200, Guangdong, P. R. China;

Corresponding?author：

WANGZhi-gang, Email: 13302507911@189.cn

Keywords：

Esophageal cancer; Enteral Nutrition; Liver function; Kidney function; Gastrointestinal function

DOI：

10.7507/1007-4848.20140141

Video：

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Objective To investigate the influence of enteral nutrition (EN) and total parenteral nutrition (TPN) on liver, kidney and gastrointestinal function in patients after esophagectomy. Methods A total of 124 patients with esophageal cancer who underwent esophagectomy in the Affiliated Hospital of Guangdong Medical College from January 2012 to August 2013 were enrolled in this study. There were 71 male and 53 female patients with their average age of 59.7 years (range 31 to 85 years). All the patients were randomly divided into an experimental group and a control group. Postoperatively, patients in the experimental group received EN via nasogastric/nasointestinal tube, and patients in the control group received TPN. Preoperatively, 1, 3 and 7 days postoperatively, plasma alanine transaminase (ALT), aspartate transaminase (AST), indirect bilirubin (I_BIL), direct bilirubin (DB), total bilirubin (TB), total protein (TP) and albumin (ALB) were examined to evaluate liver function, blood urea nitrogen (BUN) and serum creatinine (Scr) were examined to evaluate renal function. Postoperative time to first audible bowel sounds, time to first flatus, and time to first stool were examined to evaluate gastrointestinal function. Results There was no statistical difference in ALT, AST, I_BIL, DB or TB preoperatively and on the 1st postoperative day between the 2 groups (P > 0.05), but these parameters of the experimental group were significantly lower than those of the control group on the 3rd and 7th postoperative day (P < 0.05). There was no statistical difference in TP or ALB between the 2 groups (P > 0.05). There was no statistical difference in BUN or Scr preoperatively, on the 1st or 3rd postoperative day between the 2 groups (P > 0.05). BUN (4.94±1.07 mmol/L vs. 6.67± 2.88 mmol/L, P < 0.05) and Scr (52.50±12.46 μmol/L vs. 68.23±7.61 μmol/L, P < 0.05) of the experimental group were significantly lower than those of the control group on the 7th postoperative day. Postoperative time to first audible bowel sounds (42.00±1.68 hours vs. 50.00±1.54 hours), time to first flatus (64.15±10.35 hours vs. 70.64±14.73 hours) and time to first stool (4.20±1.50 days vs. 5.20 ±1.40 days) of the experimental group were significantly shorter than those of the control group (P < 0.05). Conclusion Postoperative EN can promote the recovery of gastrointestinal function, and has less influence on liver and kidney function, which is beneficial to postoperative recovery and morbidity reduction after esophagectomy.

Citation： YUShuai, WANGZhi-gang, HUANGMin-qian, LINLi-yao, XIEJian-long, BAIPei-ru. Comparison of the Influence of Enteral Nutrition and Total Parenteral Nutrition on Liver, Kidney and Gastrointestinal Function in Patients after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 498-502. doi: 10.7507/1007-4848.20140141 Copy

1.	Heller AR, R?ssler S, Litz RJ, et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med, 2006, 34 (4):972-979.
2.	黎介壽, 江志偉.營養與腫瘤治療.中國腫瘤外科雜志, 2010, 2 (1):1-2, 13.
3.	莢從正, 張建群, 譚林, 等.食管癌術后早期腸內營養的臨床應用.安徽醫學, 2013, 34 (4):426-428.
4.	Yamaguchi Y, Hihara J, Hironaka K, et al. Postoperative immunosuppression cascade and immunotherapy using lymphokine-activated killer cells for patients with esophageal cancer:possible application for compensatory anti-inflammatory response syndrome. Oncol Rep, 2006, 15 (4):895-901.
5.	Seike J, Tangoku A, Yuasa Y, et al. The effect of nutritional support on the immune function in the acute postoperative period after esopha-geal cancer surgery:total parenteral nutrition versus enteral nutrition. J Med Invest, 2011, 58 (1-2):75-80.
6.	Takagi K, Yamamori H, Toyoda Y, et al. Modulating effects of the feeding route on stress response and endotoxin translocation in severely stressed patients receiving thoracic esophagectomy. Nutrition, 2000, 16 (5):355-360.
7.	Purcel PN, Davis K, Branson RD. et al. Continuous duodenal fee-ding restores blood flow and increases gut oxygen utiligation during PEEP ventilation for lung injury. Am J Surg, 1993, 165 (1):188-193.
8.	黎介壽.腸內營養——外科臨床營養支持的首選途徑.中國實用外科雜志, 2003, 23 (2):67-67.
9.	Qin HL, Su ZD, Hu LG, et al. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis. Clin Nutr, 2002, 21 (6):469-473.
10.	秦環龍, 吳肇漢.中、長鏈脂肪乳劑對肝硬變門脈高壓術后脂蛋白、肝功能及膽紅素代謝的影響.臨床外科雜志, 1998, 6 (2):67-69.
11.	秦環龍, 吳肇漢.腸內營養在外科臨床中的應用.腸外與腸內營養, 2000, 7 (2):119-121.
12.	Braga M, Gianotti L, Gentilini O, et al. Feeding the gut early after digestive surgery:results of a nine-year experience. Clin Nutr, 2002, 21 (1):59-65.
13.	李軍, 李衛國, 秦建偉.食管、賁門癌病人術后早期腸內營養治療的分析.腸外與腸內營養, 2007, 11 (6):365-366, 369.
14.	Carter DC, 主編.創傷.北京:解放軍出版社, 1984. 391-392.
15.	羅在瓊, 郭志祥, 李敏.食管賁門癌術后早期腸內營養護理進展.全科護理, 2010, 8 (17):1577-1578.
16.	Rayes N, Hansen S, Seehofer D, et al. Early enteral supply of fiber and Lactobacilli versus conventional nutrition:a controlled trial in patients with major abdominal surgery. Nutrition, 2002, 18 (7/8):609-615.
17.	卜德勇, 馬蕓.圍手術期腸內營養支持的研究進展.中國老年保健醫學, 2012, 10 (2):49-52.
18.	Baker A, Wooten LA, Malloy M. Nutritional considerations after gastrectomy and esophagectomy for malignancy. Curr Treat Options Oncol, 2011, 12 (1):85-95.
19.	樊秀葉.食管癌和胃癌患者術后腸內營養支持護理體會.中國臨床營養雜志, 2008, 16 (2):111-112.
20.	張勁弩, 肖啟恩, 李學軍, 等.術后經空腸造瘺管實施早期腸內營養對胃腸道腫瘤的療效.醫學臨床研究, 2007, 24 (6):974-975.
21.	寧桂芝, 夏宏偉, 呂麗艷, 等.食道癌病人圍手術期腸內營養支持.齊齊哈爾醫學院學報, 2009, 30 (15):1856-1857.
22.	戚智冬, 遲強.腸功能障礙與腸內營養.中華胃腸外科雜志, 2012, 15 (5):530-532.
23.	徐衛華, 錢永躍.食管癌兩切口術后病人早期行不同途徑腸內營養的研究.腸外與腸內營養, 2009, 16 (2):87-89.
24.	蔣朱明, 吳蔚然, 主編.腸內營養.第2版.北京:人民衛生出版社, 2002. 254-256.
25.	Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66 (1):16-24.
26.	朱明煒.規范化的圍手術期腸外和腸內營養支持.臨床藥物治療雜志, 2008, 6 (2):52-55, 60.

1. Heller AR, R?ssler S, Litz RJ, et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med, 2006, 34 (4):972-979.
2. 黎介壽, 江志偉.營養與腫瘤治療.中國腫瘤外科雜志, 2010, 2 (1):1-2, 13.
3. 莢從正, 張建群, 譚林, 等.食管癌術后早期腸內營養的臨床應用.安徽醫學, 2013, 34 (4):426-428.
4. Yamaguchi Y, Hihara J, Hironaka K, et al. Postoperative immunosuppression cascade and immunotherapy using lymphokine-activated killer cells for patients with esophageal cancer:possible application for compensatory anti-inflammatory response syndrome. Oncol Rep, 2006, 15 (4):895-901.
5. Seike J, Tangoku A, Yuasa Y, et al. The effect of nutritional support on the immune function in the acute postoperative period after esopha-geal cancer surgery:total parenteral nutrition versus enteral nutrition. J Med Invest, 2011, 58 (1-2):75-80.
6. Takagi K, Yamamori H, Toyoda Y, et al. Modulating effects of the feeding route on stress response and endotoxin translocation in severely stressed patients receiving thoracic esophagectomy. Nutrition, 2000, 16 (5):355-360.
7. Purcel PN, Davis K, Branson RD. et al. Continuous duodenal fee-ding restores blood flow and increases gut oxygen utiligation during PEEP ventilation for lung injury. Am J Surg, 1993, 165 (1):188-193.
8. 黎介壽.腸內營養——外科臨床營養支持的首選途徑.中國實用外科雜志, 2003, 23 (2):67-67.
9. Qin HL, Su ZD, Hu LG, et al. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis. Clin Nutr, 2002, 21 (6):469-473.
10. 秦環龍, 吳肇漢.中、長鏈脂肪乳劑對肝硬變門脈高壓術后脂蛋白、肝功能及膽紅素代謝的影響.臨床外科雜志, 1998, 6 (2):67-69.
11. 秦環龍, 吳肇漢.腸內營養在外科臨床中的應用.腸外與腸內營養, 2000, 7 (2):119-121.
12. Braga M, Gianotti L, Gentilini O, et al. Feeding the gut early after digestive surgery:results of a nine-year experience. Clin Nutr, 2002, 21 (1):59-65.
13. 李軍, 李衛國, 秦建偉.食管、賁門癌病人術后早期腸內營養治療的分析.腸外與腸內營養, 2007, 11 (6):365-366, 369.
14. Carter DC, 主編.創傷.北京:解放軍出版社, 1984. 391-392.
15. 羅在瓊, 郭志祥, 李敏.食管賁門癌術后早期腸內營養護理進展.全科護理, 2010, 8 (17):1577-1578.
16. Rayes N, Hansen S, Seehofer D, et al. Early enteral supply of fiber and Lactobacilli versus conventional nutrition:a controlled trial in patients with major abdominal surgery. Nutrition, 2002, 18 (7/8):609-615.
17. 卜德勇, 馬蕓.圍手術期腸內營養支持的研究進展.中國老年保健醫學, 2012, 10 (2):49-52.
18. Baker A, Wooten LA, Malloy M. Nutritional considerations after gastrectomy and esophagectomy for malignancy. Curr Treat Options Oncol, 2011, 12 (1):85-95.
19. 樊秀葉.食管癌和胃癌患者術后腸內營養支持護理體會.中國臨床營養雜志, 2008, 16 (2):111-112.
20. 張勁弩, 肖啟恩, 李學軍, 等.術后經空腸造瘺管實施早期腸內營養對胃腸道腫瘤的療效.醫學臨床研究, 2007, 24 (6):974-975.
21. 寧桂芝, 夏宏偉, 呂麗艷, 等.食道癌病人圍手術期腸內營養支持.齊齊哈爾醫學院學報, 2009, 30 (15):1856-1857.
22. 戚智冬, 遲強.腸功能障礙與腸內營養.中華胃腸外科雜志, 2012, 15 (5):530-532.
23. 徐衛華, 錢永躍.食管癌兩切口術后病人早期行不同途徑腸內營養的研究.腸外與腸內營養, 2009, 16 (2):87-89.
24. 蔣朱明, 吳蔚然, 主編.腸內營養.第2版.北京:人民衛生出版社, 2002. 254-256.
25. Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66 (1):16-24.
26. 朱明煒.規范化的圍手術期腸外和腸內營養支持.臨床藥物治療雜志, 2008, 6 (2):52-55, 60.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of the Influence of Enteral Nutrition and Total Parenteral Nutrition on Liver, Kidney and Gastrointestinal Function in Patients after Esophagectomy

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