Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the del...Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.展开更多
目的系统评价空肠造瘘管对比鼻空肠营养管行肠内营养在食管癌根治术后的疗效与安全性。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库,搜集关于空肠造瘘管对比...目的系统评价空肠造瘘管对比鼻空肠营养管行肠内营养在食管癌根治术后的疗效与安全性。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库,搜集关于空肠造瘘管对比鼻空肠营养管行肠内营养在食管癌根治术后的临床效果研究,检索时限均为建库至2021年10月。采用RevMan 5.4软件进行Meta分析。结果最终纳入26篇文献,其中17篇随机对照研究、9篇队列研究,共包含35808例患者。Meta分析结果显示:空肠造瘘管组术后排气时间[MD=–4.27,95%CI(–5.87,–2.66),P=0.001]、肺部感染发生率[OR=1.39,95%CI(1.06,1.82),P=0.02]、脱管发生率[OR=0.11,95%CI(0.04,0.30),P=0.001]、堵管发生率[OR=0.47,95%CI(0.23,0.97),P=0.04]、鼻咽部不适[OR=0.04,95%CI(0.01,0.13),P=0.001]、鼻咽黏膜破损发生率[OR=0.13,95%CI(0.04,0.42),P=0.008]、恶心呕吐发生率[OR=0.20,95%CI(0.08,0.47),P=0.003]均短于或低于鼻空肠营养管组,术后血清白蛋白水平[MD=5.75,95%CI(5.34,6.16),P=0.001]高于鼻空肠营养管组,且差异具有统计学意义。但空肠造瘘管组术中操作时间[MD=13.65,95%CI(2.32,24.98),P=0.02]、术后营养管留置时间[MD=17.81,95%CI(12.71,22.91),P=0.001]长于鼻空肠营养管组,同时其术后肠梗阻发生率[OR=6.08,95%CI(2.55,14.50),P=0.001]高于鼻空肠营养管组,差异具有统计学意义。而两组术后住院时间、吻合口瘘发生率差异无统计学意义(P>0.05)。结论空肠造瘘管在食管癌根治术后行肠内营养过程中,临床治疗效果更佳,置管舒适性更高,但是肠梗阻发生率较传统鼻空肠营养管更高。展开更多
目的系统评价经鼻肠内营养管(NJT)与空肠造口置管(JT)两种不同营养途径在上消化道改建术后病人肠内营养的临床效果。方法计算机检索PubMed、EMbase、Web of science、The Cochrane Library(2015年第9期)、中国生物医学文献数据库(CBM)...目的系统评价经鼻肠内营养管(NJT)与空肠造口置管(JT)两种不同营养途径在上消化道改建术后病人肠内营养的临床效果。方法计算机检索PubMed、EMbase、Web of science、The Cochrane Library(2015年第9期)、中国生物医学文献数据库(CBM)、中国知网、维普、万方数据等数据库,查找所有比较术后NJT与JT行肠内营养的上腹部肠道改建手术的随机对照试验(RCT),检索时限为从建库至2015年9月。由2位研究者按纳入与排除标准独立筛选文献、提取资料和评价文献质量后,进行Meta分析。结果最终纳入7个RCT,包括544例病人。Meta结果显示:虽然JT组术后总并发症发生率少于NJT组[RR=0.58,95%CI(0.38,0.90),P=0.02],但与管道相关并发症发生率两组差异无统计学意义[RR=1.30,95%CI(0.93,1.81),P=0.12];两组肠内营养置管后不能耐受发生率差异无统计学意义[RD=-0.08,95%CI(-0.20,0.03),P=0.16];术后主要并发症吻合口漏及肺炎两组差异无统计学意义(P>0.05);肠功能恢复时间JT组明显短于NJT组[SMD=-1.19,95%CI(-1.77,-0.60),P<0.0001],两组比较差异有统计学意义。结论两种肠内营养途径均是安全有效的方法,但JT在促进肠功能恢复和减少术后总并发症方面更有优势。展开更多
Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute...Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.展开更多
目的系统评价空肠造口与鼻肠管两种肠内营养(EN)途径用于消化道肿瘤术后患者的效果。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方全文数据库、维普中文科技期刊数据库(VIP)、百度学术、Pub Med/MEDLINE、Web of S...目的系统评价空肠造口与鼻肠管两种肠内营养(EN)途径用于消化道肿瘤术后患者的效果。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方全文数据库、维普中文科技期刊数据库(VIP)、百度学术、Pub Med/MEDLINE、Web of Science、Cochrane Library各大数据库的随机对照试验研究(RCT),检索时间限制在2000年1月至2017年5月。由2名研究者采用Cochrane系统评价法独立进行文献质量评价和数据提取,比较两种EN途径对患者术后营养状况及相关并发症发生率的影响。采用Rev Man5.3软件进行Meta分析。结果最终纳入12篇随机对照研究,共842名患者。Meta分析结果显示:空肠造口组与鼻肠管组相比差异有统计学意义的是:白蛋白水平P<0.05;总蛋白水平P<0.05;导管脱位发生率P<0.05;恶心呕吐发生率P<0.000;肺部感染发生率P<0.01。两组相比差异无统计学意义的是:体质量P<0.05。结论消化道肿瘤患者术后经空肠造口行EN后营养状况较好,且并发症较少,应用较为安全,是更为合理的EN途径。展开更多
Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from pla...Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from placement of the tube, mechanical problems related to the location or function and development of focally thickened small-bowel folds. A 76-year old man who presented with multiple medical diseases was admitted to our hospital due to aspiration pneumonia with acute respiratory failure and septic shock. He underwent exploratory laparotomy with feeding jejunostomy using a 14-French nasogastric tube for nutritional support. However, occlusion of the feeding tube was found 30 d after operation, and a rare complication of knot formation in the tube occurred after a new tube was replaced. On the following day, the tube was removed and replaced with a similar tube, which was placed into the jejunum for only 15 cm. The patient's feedings were maintained smoothly for two months. Knot formation in the feeding tube seems to be very rare. To our knowledge, this is the third case in the literature review. Its incidence is probably related to the length of the tube inserted into the lumen.展开更多
文摘Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.
文摘目的系统评价经鼻肠内营养管(NJT)与空肠造口置管(JT)两种不同营养途径在上消化道改建术后病人肠内营养的临床效果。方法计算机检索PubMed、EMbase、Web of science、The Cochrane Library(2015年第9期)、中国生物医学文献数据库(CBM)、中国知网、维普、万方数据等数据库,查找所有比较术后NJT与JT行肠内营养的上腹部肠道改建手术的随机对照试验(RCT),检索时限为从建库至2015年9月。由2位研究者按纳入与排除标准独立筛选文献、提取资料和评价文献质量后,进行Meta分析。结果最终纳入7个RCT,包括544例病人。Meta结果显示:虽然JT组术后总并发症发生率少于NJT组[RR=0.58,95%CI(0.38,0.90),P=0.02],但与管道相关并发症发生率两组差异无统计学意义[RR=1.30,95%CI(0.93,1.81),P=0.12];两组肠内营养置管后不能耐受发生率差异无统计学意义[RD=-0.08,95%CI(-0.20,0.03),P=0.16];术后主要并发症吻合口漏及肺炎两组差异无统计学意义(P>0.05);肠功能恢复时间JT组明显短于NJT组[SMD=-1.19,95%CI(-1.77,-0.60),P<0.0001],两组比较差异有统计学意义。结论两种肠内营养途径均是安全有效的方法,但JT在促进肠功能恢复和减少术后总并发症方面更有优势。
文摘Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.
文摘Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from placement of the tube, mechanical problems related to the location or function and development of focally thickened small-bowel folds. A 76-year old man who presented with multiple medical diseases was admitted to our hospital due to aspiration pneumonia with acute respiratory failure and septic shock. He underwent exploratory laparotomy with feeding jejunostomy using a 14-French nasogastric tube for nutritional support. However, occlusion of the feeding tube was found 30 d after operation, and a rare complication of knot formation in the tube occurred after a new tube was replaced. On the following day, the tube was removed and replaced with a similar tube, which was placed into the jejunum for only 15 cm. The patient's feedings were maintained smoothly for two months. Knot formation in the feeding tube seems to be very rare. To our knowledge, this is the third case in the literature review. Its incidence is probably related to the length of the tube inserted into the lumen.
