创伤骨科患者创伤严重程度和血浆D二聚体水平的相关分析

Background  The correlation between the plasma D-dimer level and deep vein thrombosis has not been conclusive in various studies. The aim of this research was to study the relationship between plasma D-dimer levels and the severity of orthopedic trauma by retrospective examination of orthopedic trauma cases.

Methods  Clinically acute trauma and non-acute trauma patients were selected and their plasma D-dimer levels were measured. Plasma D-dimer levels in patients of these two groups were compared. The relationship between the plasma D-dimer level and the severity of the trauma was also studied.

Results  There were 548 cases in the acute trauma group and 501 cases in the non-acute trauma group. The levels of plasma D-dimer were significantly higher in the acute trauma group than in the non-acute trauma group (P <0.01). In the acute trauma group, the correlation between the D-dimer level and the number of fractures was a positive linear correlation (r=0.9532).

Conclusions  Elevated plasma D-dimer is common in trauma patients. The D-dimer level and the number of fractures in the trauma patients are closely correlated. D-dimer is not only an indicator for the diagnosis of deep vein thrombosis and pulmonary embolus, but also an indicator of the severity of trauma in acute trauma patients.

     

Phase II Clinical Study on the Modified DCF Regimen for Treatment of Advanced Gastric Carcinoma

Background  A phase III trial involving docetaxel, cisplatin, and fluorouracil (DCF) in the treatment of advanced gastric cancer was shown to have superior efficacy compared to cisplatin and fluorouracil alone, but with a high rate of hematologic toxicity. To reduce toxicity while maintaining the efficacy of DCF, we reduced the doses of docetaxel (D) and cis-platinum (CDDP), and administered 5-fluorouracil (5-FU) via a continuous intravenous (CIV) infusion.

Methods  Chemotherapy-naive patients with gastric adenocarcinomas received D (60 mg/m² 1 hour on day 1), CDDP (30 mg/m² on days 1 and 2), and 5-FU (1500 mg×m^-2×24 h^-1 CIV on days 1 and 8 every 3 weeks). The primary endpoint was the response rate.

Results  Fourteen patients were enrolled. Based on the efficacy evaluation following at least 2 cycles of treatment, there was 7.1% complete remission (CR), 71% partial remission (PR), 14% stable disease (NC/SD), and 7.1% progressive disease (PD). The median survival time was 13 months. Nine patients (64%) had grade III-IV neutropenia, and 4 patients (29%) had grade IV neutropenia, among whom 1 had grade IV neutropenia with grade III nausea and vomiting.

Conclusion  The modified DCF regimen is highly active and has a favorable toxicity profile in Chinese patients with gastric cancer.

     

动静脉结合的新辅助化疗治疗56例进展期胃癌的回顾性分析

Background  Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced gastric cancer.

Methods  A total of 56 histologically proven gastric cancer patients, who were considered to be stage II or higher with metastatic lymph nodes and with or without distant metastasis (T_2–4, N_1–3, and M_0–1), were treated with a neoadjuvant chemotherapy. Patients received a combination of intravenous 5-Fu (370 mg/m²) and leucovorin (200 mg/m²) on days 1–5, and intra-arterial etoposide (80 mg/m²) and cisplatin (80 mg/m²) on days 6 and 20. After two cycles of preoperative chemotherapy, patients with resectable tumors underwent laparotomy.

Results  All patients finished two cycles of chemotherapy. The overall response rate was 78.57% (44 cases), of which 7.14% (four cases) clinical complete response. Forty-six patients underwent resection, including 21 initially unresectable diseases. R0 resection rate for prechemotherapy resectable and unresectable diseases was 96.15% (25/26 cases) and 66.67% (20/30 cases), respectively. Pathological complete response was observed in 8.70% of patients. Toxicity was moderate and there were no chemotherapy-related deaths. With a median follow-up of 31 months (range 6–76 months), the 5-year survival rate for the whole group and patients with initially resectable tumors were 21.8% and 42.3%, respectively. The median survival for initially resectable and unresectable patients were 41 months (95%CI, 31.006–50.994) and 18 months (95%CI, 13.399–22.601; P <0.01), respectively.

Conclusion  Preliminary results proved that the combined intensive chemotherapy was a safe and promising regimen for pre-operative treatment of advanced gastric cancer.

     

Clinical applications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in carcinoma of unknown primary

Background  Carcinoma of unknown primary (CUP) encompasses a heterogeneous group of tumors with varying clinical features. The management of patients of CUP remains a clinical challenge. The purpose of this study was to evaluate the clinical applications of integrated ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) information in patients with CUP, including detecting the occult primary tumor and effecting on disease therapy.

Methods  One hundred and forty-nine patients with histologically-proven metastases of CUP were included. For all patients, the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 minutes after intravenous injection of 350–425 MBq of ¹⁸F-FDG.

Results  In 24.8% of patients, FDG PET/CT detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG PET/CT in detecting unknown primary tumors were 86.0%, 87.7%, and 87.2%, respectively. FDG PET/CT imaging also led to the detection of previously unrecognized metastases in 29.5% of patients. Forty-seven (31.5%, 47 of 149) patients underwent a change in therapeutic management.

Conclusions  FDG PET/CT is a valuable tool in patients with CUP, because it assisted in detecting unknown primary tumors and previously unrecognized distant metastases, and optimized the mangement of these patients.

     

Bleb-associated endophthalmitis treated by sclera patch graft, vitrectomy and endoscopic cyclophotocoagulation

Background  Bleb-associated endophthalmitis (BAE) is a rare but severe complication of trabeculectomy with poor outcome. Various surgical methods were explored to treat such patients. However, there is no defined protocol. The aim of this study was to describe a new combined operation, and to demonstrate the outcome of the treatment.

Methods  Nine patients with BAE were enrolled in our study. The combined operation including pars plana vitrectomy (PPV), sclera patch graft (SPG) and endoscopic cyclophotocoagulation (ECP) was used to treat these patients.

Results  In the follow-up of 18–24 months, all patients with the endophthalmitis were cured, the useful visual acuity was preserved in 7 patients, and the intraocular pressure (IOP) of 8 patients was controlled just after first operation, only one needed another trans-scleral cyclophotocoagulation.

Conclusion  This combined operation is a useful method for treating the patients with BAE, with SPG and vitrectomy to control the endophthalmitis and ECP to balance the postoperative IOP.

     

Impact of gender and body mass index on surgical outcomes following gastrectomy: an Asia-Pacific perspective

Background  Although surgeons may expect difficulties in performing gastrectomy on patients with high body mass index (BMI), it is not always the case, especially regarding patient gender. The aim of this study was to evaluate gender as a predictive factor of surgical outcomes related to obesity, as defined by the World Health Organization for the Asia-Pacific region.

Methods  Data of short-term surgical outcomes were obtained from 243 patients following open curative distal subtotal gastrectomy for gastric adenocarcinoma. Patients were classified into two groups by gender, and were further classified by BMI into group A (BMI ≥25 kg/m²) and group B (BMI <25 kg/m²). The operation time, extent of surgical bleeding, the number of resected lymph nodes, postoperative hospital stay, serum amylase levels, white blood cell count and postoperative complications were accessed for each group.

Results  Within male patients, the operation time tended to be longer in group A, albeit without statistical significance (P=0.075). However, the extent of surgical bleeding was significantly larger in group A (P=0.002). Within female patients, there were no such differences. When comparisons were made between male and female patients in group A, the operation time was significantly longer in male patients (P=0.019). The extent of bleeding tended to be larger in males, albeit without statistical significance (P=0.065). No such differences were seen when comparisons were made between male and female patients in group B.

Conclusions  Disparity in surgical outcomes between male and female patients does exist, particularly in patients with high BMI. Gender adjustment of BMI must be performed when predicting surgical outcomes.

     

Progression of solitary and multifocal papillary thyroid carcinoma — a retrospective study of 368 patients

Background  Papillary thyroid carcinoma (PTC) represents one of the most frequent endocrine malignancies. Several factors have been found to be involved in determining the outcome of treatment for patients with PTC. Large tumor size, diagnosis at an early age, extra-thyroidal invasion, aggressive histological variants, and distant metastases are the most important determinants of a poor outcome. BRAF^V600E mutation has been found to be a major genetic alteration in PTC. This study aimed to evaluate progression in patients with multifocal and solitary PTC.

Methods  We performed a retrospective study to analyze 368 patients with PTC who underwent surgery, including 282 patients with solitary PTC and 86 patients with multifocal PTC. The status of BRAF^V600E mutation in all tumor foci from multifocal PTC was detected.

Results  Our study suggested that multifocal PTC was more related to lymph node metastasis and vascular invasion than solitary PTC. However, the distant metastasis rate and 10-year survival rate showed no difference between these two groups. The number of tumor foci did not affect progression of disease in multifocal PTC patients. Lymph node metastasis in multifocal PTC patients was associated with larger tumors, diagnosis at early stage, and extra-thyroidal invasion.

Conclusion  The status of BRAF^V600E mutation was more frequent in multifocal PTC patients with lymph node metastasis and diagnosis at later age.

     

Impact of Fish Oil Enriched Total Parenteral Nutrition on Elderly Patients After Colorectal cancer Surgery

Background  Polyunsaturated omega-3 fatty acids may beneficially influence healing processes and patient outcomes. The aim of this research was to study the clinical efficacy of fish oil enriched total parenteral nutrition in elderly patients after colorectal cancer surgery.

Methods  Fifty-seven elderly patients with colorectal cancer were enrolled in this prospective, randomized, double-blind, controlled clinical trial. All patients received isocaloric and isonitrogenous total parenteral nutrition by continuous infusion (20–24 hours per day) for seven days after surgery. The control group (n=28) received 1.2 g/kg soybean oil per day, whereas the treatment group (n=29) received 0.2 g/kg fish oil and 1.0 g/kg soybean oil per day. Blood samples were taken pre-operatively, and at days one and eight after the operation. The plasma levels of CD4, CD8, CD4/CD8, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured. Clinical outcomes were then analysed.

Results  Patient characteristics were comparable between the two groups. At day eight post-surgery, IL-6, TNF-α and CD8 titres were lower in the treatment group when compared to the control group; these results reached statistical significance. In the treatment group, there were fewer infectious complications and incidences of systemic inflammatory response syndrome (SIRS), and shorter lengths of hospital stay were observed. The total cost of medical care was comparable for the two groups. No serious adverse events occurred in either group.

Conclusions  Fish oil 0.2 g/kg per day administrated to elderly patients after colorectal surgery was safe and may shorten the length of hospital stay and improve clinical outcomes.

     

Influential factors and effect evaluation of the intra-operative puncture biopsy for pancreatic masses

Background  Polyunsaturated omega-3 fatty acids may beneficially influence healing processes and patient outcomes. The aim of this research was to study the clinical efficacy of fish oil enriched total parenteral nutrition in elderly patients after colorectal cancer surgery.

Methods  Fifty-seven elderly patients with colorectal cancer were enrolled in this prospective, randomized, double-blind, controlled clinical trial. All patients received isocaloric and isonitrogenous total parenteral nutrition by continuous infusion (20–24 hours per day) for seven days after surgery. The control group (n=28) received 1.2 g/kg soybean oil per day, whereas the treatment group (n=29) received 0.2 g/kg fish oil and 1.0 g/kg soybean oil per day. Blood samples were taken pre-operatively, and at days one and eight after the operation. The plasma levels of CD4, CD8, CD4/CD8, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured. Clinical outcomes were then analysed.

Results  Patient characteristics were comparable between the two groups. At day eight post-surgery, IL-6, TNF-α and CD8 titres were lower in the treatment group when compared to the control group; these results reached statistical significance. In the treatment group, there were fewer infectious complications and incidences of systemic inflammatory response syndrome (SIRS), and shorter lengths of hospital stay were observed. The total cost of medical care was comparable for the two groups. No serious adverse events occurred in either group.

Conclusions  Fish oil 0.2 g/kg per day administrated to elderly patients after colorectal surgery was safe and may shorten the length of hospital stay and improve clinical outcomes.

     

Polymorphisms of dihydropyrimidine dehydrogenase gene and clinical outcomes of gastric cancer patients treated with fluorouracil-based adjuvant chemotherapy in Chinese population

Background  Dihydropyrimidine dehydrogenase (DPD), a key enzyme involved in the catabolism of 5-fluorouracil (5-FU), is the attractive candidate for pharmacogenetic research on efficacies and toxicities of 5-FU. The aim of this study is to explore the association between polymorphisms of dihydropyrimidine dehydrogenase gene (DPYD) and clinical outcomes of gastric cancer patients treated with fluorouracil-based adjuvant chemotherapy in the Chinese population.

Methods  Three hundred and sixty-two patients with gastric cancer in the Chinese population were treated with fluorouracil-based adjuvant chemotherapy. The single nucleotide polymorphic genotypes of DPYD were determined by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF-MS) using DNA samples isolated from peripheral blood collected before treatment.

Results  The average response rate for chemotherapy was 46.7%. A significantly different distribution of the rs1801159 (c²=8.76, P=0.012) genotypes was observed. Homozygous genotype rs1801159A/A was over-represented in responsive patients. Conversely, carriers of the rs1801159A/G genotype were prevalent in non-responsive patients. In the haplotype association analysis, there was significant difference in global haplotype distribution between the groups (c²=3.96, P=0.0465).

Conclusions  These results suggest that polymorphisms of rs1801159 in DPYD may be used as valuable predictors of the response to fluorouracil-based chemotherapy for gastric cancer patients in the Chinese population. Well-designed, comprehensive, and prospective studies on determining these polymorphisms of DPYD as predictive markers for gastric cancer in response to fluorouracil-based therapies are warranted.

     

肠内营养治疗腹部手术后胃排空障碍

目的探讨肠内营养在胃排空障碍治疗中的作用。方法 43例腹部手术后胃排空障碍患者中,有13例应用肠外营养（PN组）,30例利用鼻肠管或空肠造瘘管灌注瑞素施行肠内营养（EN组）。比较两组术后住院时间、胃肠减压量、胃排空障碍恢复时间及术后体质量减轻数,评估肠内营养的疗效。结果经治疗后与肠外营养组比较,肠内营养组术后住院时间平均减少（7.9±2）d,胃排空障碍恢复时间平均缩短（4±1）d,胃肠减压量较PN组明显减少,体重减少较PN组少（3.1±0.1）kg。结论肠内营养能促进胃肠道功能恢复,有利于机体营养状况改善,是治疗腹部手术后胃瘫的有效手段。     

肠内营养对胃癌术后恢复的影响

目的:观察胃癌根治术后早期肠内营养的临床疗效及评价其安全性、可行性。方法:对本院普外科收治的60例胃癌手术患者治疗作回顾性分析,随机分成对照组(共30例)和肠内营养(Enteral Nutrition,EN)组(共30例)。对照组术后常规处理,EN组术后24~48h开始经空肠营养管滴注肠内营养液共7d,两组营养支持均等热量、等氮量,术后8d进行人体相关指标测量,进行支持前后自身对照及组间比较。观察两组患者术前和术后的营养状态、肠功能恢复情况、住院时间及住院费用等。结果:EN组除1例因腹胀明显不耐受外均按计划完成治疗,治愈出院,EN组和对照组在并发症比较上差异无显著性,EN组肠功能恢复时间早于对照组,但两组排便功能的恢复无显著差异(P>0.05),术后8d两组体重均明显减轻(P<0.01),而术前、术后白蛋白的改变无显著差异(P>0.05),EN组住院时间及营养费用少于对照组。结论:胃癌根治术后早期肠内营养安全、简便、经济,优于肠外营养。与TPN支持相比,EN有利于促进患者的胃肠功能及营养状况恢复,胃癌根治术后EEN支持是安全可行的,是合理、有效的营养支持方式;患者营养状态恢复快、对肝功能影响小。     

延期留置空肠穿刺造口管肠内营养在老年胃癌患者术后营养状态恢复中的应用

目的探讨延期留置空肠穿刺造口管肠内营养在老年胃癌患者术后营养状态恢复中的应用。方法56例老年胃癌根治术患者随机分为2组：A组和B组，组28例。2组患者均在术后经空肠穿刺造口管行早期肠内营养支持治疗。B组术后行早期肠内营养支持治疗至出院时结束，A组术后行早期肠内营养支持治疗至出院后2周。观察2组患者营养状况的恢复及并发症的发生情况。结果A组出院前白细胞计数（WBC）、血红蛋白（Hb）、血清白蛋白（Alb）、前白蛋白（PA）、转铁蛋白（TRF）水平与B组比较差异均无统计学意义（P均〉0．05）。A组出院后WBC、Hb、Alb、PA、TRF水平与B组比较差异均有统计学意义（P均〈0．05）。A组体质量与B组比较差异无统计学意义（P〉0．05）。A组导管堵塞5例（17．9％），导管脱落l例（3．6％），腹壁局部软组织感染1例（3．6％）；B组无并发症发生。结论延期留置空肠穿刺造口管肠内营养可以促进老年胃癌患者术后营养状态的恢复。     

老年胃癌患者营养风险筛查及术后早期肠内营养治疗的研究

目的 了解老年胃癌患者营养状况,为营养治疗提供依据,观察早期肠内营养支持对老年胃癌术后患者的治疗意义.方法 选取2011年10月～ 2013年10月期间温州医科大学附属第一医院收治52例老年胃癌患者作为研究对象,应用营养风险筛查2002（NRS2002）进行营养风险评分,NRS2002评分为3分以下的10例患者未进行营养支持治疗（no nutrition,NN）.采用数字表法将存在营养风险的42例老年胃癌术后患者随机分为早期肠内营养（early enteral nutrition,EN）组和肠外营养（parental nutrition,PN）组,EN组2O例术中置鼻肠管,给予早期肠内营养治疗,PN组22例给予肠外营养治疗,观察并比较两组患者术后肠道功能恢复时间、住院时间和费用;测定两组患者术前和术后1周白蛋白（Alb）、前白蛋白（PA）营养指标以及血CD3％、CD4％、CD8％、CD4/CD8免疫指标并比较.结果 NRS2002评分结果显示,总评分在3分以上者在老年胃癌患者中所占比例为80.8％ （42/52）;EN组肠道功能恢复时间为2.5 ±0.6天,平均住院天数17.1 ±3.5天,均低于PN组（P＜0.05）,住院费用3.3±0.6万元,显著低于PN组（P＜0.01）;治疗1周后EN组血前白蛋白由116.2±11.7mg/L升高为289.5±18.6mg/L（P＜0.01）,比较PN组上升差异有统计学意义（P＜0.01）;EN组治疗1周后CD3％、CD4％、CD4/CD8较治疗前均升高（P＜0.01）,治疗后同PN组相比,CD4％、CD4/CD8上升更明显（P＜0.01）,而CD8％下降差异有统计学意义（P＜0.05）.NN组在治疗1周后白蛋白及前白蛋白较术前无明显变化（P＞0.05）.结论 NRS2002评分指导老年胃癌患者营养治疗方面具有一定的有效性.老年胃癌患者营养风险概率较高,术后早期EN能更好地加强老年胃癌患者营养状况,促进肠道功能恢复,改善免疫功能,缩短住院时间,减少医疗费用,值得临床应用.     

两种评定营养不良方法的对比研究

目的 运用两种评定营养不良方法对比胃癌、结肠癌、直肠癌、肠梗阻患者的营养不良发生率.方法 对住院患者进行定点连续采样,分别采用BMI＜18.5 kg/m2及NRS2002营养风险筛查工具中营养受损部分评分大于或等于3分评定营养不良,进而对比其发生率.结果 获得符合标准226例患者.使用BMI评定营养不良发生率(11.06％)低于使用NRS2002营养风险筛查工具中营养受损部分评定营养不良发生率(14.60％).调查科室的营养支持情况结果发现合乎规范的营养支持占7.96％,不规范的营养支持占17.26％,极不规范营养支持占5.31％.结论 使用NRS2002营养受损部分判断营养不良的方法值得推广.     

结直肠肿瘤患者围手术期肠内肠外营养支持的对比研究

目的比较结直肠肿瘤患者围手术期肠内营养(enteral nutrition,EN)、肠外营养(parenteral nutrition,PN)支持的效果。方法48例结直肠肿瘤患者随机分为EN和PN两组,各24例。两组给予等氮、等热量营养支持,从术前3d肠道准备期开始,术后24h内继续营养支持至术后第5d。EN组口服或经鼻肠管输注肠内营养剂,PN组经外周或中心静脉进行营养支持。测定各项观察指标并比较。结果两组患者体质量(body weight,BW),三头肌皮褶厚度(triceps skin fold,TSF),惯用手握力(grasp strength,GS),总淋巴细胞计数(total lymphocyte count,TLC),前白蛋白(prealbumin,PA),血浆白蛋白(albumin,ALB)营养支持前后无差异;PN组纤维结合蛋白营养后低于营养前,但EN患者PN营养支持前后无变化。两组患者营养后BW、TSF、GS、LYM、FN、PA、ALB水平无差异。EN组患者术后肛门排气时间早于PN组,住院时间短,但无统计学意义。EN组患者平均营养费约为PN组的1/3。结论EN可改善患者营养不良状况,保持肠屏障功能,利于术后肠功能的恢复,益于术前准备的肠道清洁。     

胃癌患者术前PG-SGA评分与人体成分的相关性

目的 探讨胃癌患者术前主观整体评估(PG-SGA)评分与人体成分的相关性.方法 选择天津市第三中心医院2015年6月至2016年10月收治的82例胃癌患者为研究对象,均进行PG-SGA量表评估及人体成分测定,PG-SGA量表得分为0～3分者纳入营养良好组(n=25),4分以上者纳入营养不良组(n=57).比较两组患者人体成分指标,以及PG-SGA评分与人体成分指标的相关性.结果 营养不良组患者的体质量、体质量指数(BMI)、体脂肪量、体脂百分比、瘦体组织、身体水分含量、细胞外液量分别为(51.92±6.85)kg、(18.58±1.92)kg/m2、(13.32±3.15)kg、(14.19±4.05)％、(44.13±4.96)kg、(33.02±2.64)L、(12.27±1.38)L,均明显低于营养良好组的(62.95±11.32)kg、(23.45±1.86)kg/m2、(15.87±3.32)kg、(23.37±3.31)％、(47.18±5.23)kg、(34.75±3.21)L、(13.72±1.37)L,差异均有统计学意义(P<0.05);PG-SGA评分与体质量、BMI、体脂肪量、体脂百分比、蛋白质含量、瘦体组织、体细胞量、骨骼肌量、身体水分含量、细胞外液、细胞内液均呈负相关性(P<0.05).结论 PG-SGA与人体成分指标具有较好的相关性,术前进行PG-SGA评分及人体成分测定对评估胃癌患者的营养状况和营养干预方案的制定具有重要的临床意义.     

EFFECTS OF ENTERAL AND PARENTERAL NUTRITION ON GASTROENTERIC HORMONES AND GASTRIC MOTILITY AFTER SUBTOTAL GASTRECTOMY

Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group （n=20） and PN group （n=21 ）. From the first postoperative day to the seventh day, patients received either EN （EN group） or PN （PN group） with isocalofic （84.9kJ·kg^-1·d^-1） and isonitrogenous （0.11g·kg^-1·d^-1） intake. Serum gastrin （GAS）, plasma mofilin （MTL）, and plasma cholecystokinin （CCK） were measured on preoperative day, the first and seventh postoperative day. Electrogastrography （EGG） was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy （ P 〈 0. 001 ）, but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained （ P 〈 0. 001 ）. On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group （ P 〈 0.05 ）. There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.     

胃切除患者早期肠内营养的临床观察

目的：观察胃切除患者早期肠内营养的临床效果。方法选取2008年2月-2013年5月收治的行胃切除术患者42例作为临床研究对象,将患者随机分为肠内营养组（EN组）和肠外营养组（PN组）两组,EN组采用早期肠内营养、PN组采用肠外营养,观察两组患者治疗8 d后的体重（WT）、血清总蛋白（TP）、血清白蛋白（Alb）、血清总胆红素（T-BIL）以及肛门排气时间和营养支持费用,以综合比较两种方法的效果。结果两组患者在体重（WT）、TP和Alb两项指标的差异无统计学意义（P＞0.05）,而在T-BIL,EN组（16.3±8.1）ìmol/L、PN组（23.5±9.3）ìmol/L;肛门排气时间,EN组（59.1±8.5）h,PN组（73.5±12.2）h;营养支持费用,EN组（5.3±2.1）百元,PN组（38.6±7.1）百元。两组的差异均有统计学意义（P＜0.05）,EN组显著低于对照组。结论早期肠内营养在胃切除中的应用安全简便,可以促进肠功能恢复、缩短治疗时间、节省治疗费用,因此值得在今后临床工作当中推广应用。     

不同营养支持途径对胃癌全胃切除术患者围术期营养状况的影响

目的：探讨早期肠内营养（EN ）与全肠外营养（T PN ）对胃癌全胃切除术患者围术期营养状况的影响。方法将重庆市第一人民医院消化内科2011年1月至2013年3月收治的96例胃癌全胃切除术患者分为2组,分别用EN和 T PN进行干预。结果与T PN组比较,EN组患者营养状况有较大改善,且肠道功能恢复时间、并发症均显著降低,差异有统计学意义（ P＜0．05）。结论对于胃癌患者来讲,早期进行EN支持可改善其营养状况,并增强免疫功能。