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

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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, Rössler S, Litz RJ, et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med, 2006, 34 (4):972-979.
2.	黎介寿, 江志伟.营养与肿瘤治疗.中国肿瘤外科杂志, 2010, 2 (1):1-2, 13.
3.	荚从正, 张建群, 谭林, 等.食管癌术后早期肠内营养的临床应用.安徽医学, 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.	黎介寿.肠内营养——外科临床营养支持的首选途径.中国实用外科杂志, 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.	秦环龙, 吴肇汉.中、长链脂肪乳剂对肝硬变门脉高压术后脂蛋白、肝功能及胆红素代谢的影响.临床外科杂志, 1998, 6 (2):67-69.
11.	秦环龙, 吴肇汉.肠内营养在外科临床中的应用.肠外与肠内营养, 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.	李军, 李卫国, 秦建伟.食管、贲门癌病人术后早期肠内营养治疗的分析.肠外与肠内营养, 2007, 11 (6):365-366, 369.
14.	Carter DC, 主编.创伤.北京:解放军出版社, 1984. 391-392.
15.	罗在琼, 郭志祥, 李敏.食管贲门癌术后早期肠内营养护理进展.全科护理, 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, 马芸.围手术期肠内营养支持的研究进展.中国老年保健医学, 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.	樊秀叶.食管癌和胃癌患者术后肠内营养支持护理体会.中国临床营养杂志, 2008, 16 (2):111-112.
20.	张劲弩, 肖启恩, 李学军, 等.术后经空肠造瘘管实施早期肠内营养对胃肠道肿瘤的疗效.医学临床研究, 2007, 24 (6):974-975.
21.	宁桂芝, 夏宏伟, 吕丽艳, 等.食道癌病人围手术期肠内营养支持.齐齐哈尔医学院学报, 2009, 30 (15):1856-1857.
22.	戚智冬, 迟强.肠功能障碍与肠内营养.中华胃肠外科杂志, 2012, 15 (5):530-532.
23.	徐卫华, 钱永跃.食管癌两切口术后病人早期行不同途径肠内营养的研究.肠外与肠内营养, 2009, 16 (2):87-89.
24.	蒋朱明, 吴蔚然, 主编.肠内营养.第2版.北京:人民卫生出版社, 2002. 254-256.
25.	Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66 (1):16-24.
26.	朱明炜.规范化的围手术期肠外和肠内营养支持.临床药物治疗杂志, 2008, 6 (2):52-55, 60.

1. Heller AR, Rössler S, Litz RJ, et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med, 2006, 34 (4):972-979.
2. 黎介寿, 江志伟.营养与肿瘤治疗.中国肿瘤外科杂志, 2010, 2 (1):1-2, 13.
3. 荚从正, 张建群, 谭林, 等.食管癌术后早期肠内营养的临床应用.安徽医学, 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. 黎介寿.肠内营养——外科临床营养支持的首选途径.中国实用外科杂志, 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. 秦环龙, 吴肇汉.中、长链脂肪乳剂对肝硬变门脉高压术后脂蛋白、肝功能及胆红素代谢的影响.临床外科杂志, 1998, 6 (2):67-69.
11. 秦环龙, 吴肇汉.肠内营养在外科临床中的应用.肠外与肠内营养, 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. 李军, 李卫国, 秦建伟.食管、贲门癌病人术后早期肠内营养治疗的分析.肠外与肠内营养, 2007, 11 (6):365-366, 369.
14. Carter DC, 主编.创伤.北京:解放军出版社, 1984. 391-392.
15. 罗在琼, 郭志祥, 李敏.食管贲门癌术后早期肠内营养护理进展.全科护理, 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, 马芸.围手术期肠内营养支持的研究进展.中国老年保健医学, 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. 樊秀叶.食管癌和胃癌患者术后肠内营养支持护理体会.中国临床营养杂志, 2008, 16 (2):111-112.
20. 张劲弩, 肖启恩, 李学军, 等.术后经空肠造瘘管实施早期肠内营养对胃肠道肿瘤的疗效.医学临床研究, 2007, 24 (6):974-975.
21. 宁桂芝, 夏宏伟, 吕丽艳, 等.食道癌病人围手术期肠内营养支持.齐齐哈尔医学院学报, 2009, 30 (15):1856-1857.
22. 戚智冬, 迟强.肠功能障碍与肠内营养.中华胃肠外科杂志, 2012, 15 (5):530-532.
23. 徐卫华, 钱永跃.食管癌两切口术后病人早期行不同途径肠内营养的研究.肠外与肠内营养, 2009, 16 (2):87-89.
24. 蒋朱明, 吴蔚然, 主编.肠内营养.第2版.北京:人民卫生出版社, 2002. 254-256.
25. Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66 (1):16-24.
26. 朱明炜.规范化的围手术期肠外和肠内营养支持.临床药物治疗杂志, 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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