目的 比较胃窦癌伴胃窦腔或幽门梗阻患者经胃镜放置鼻空肠营养管(endoscopically nasojejunal feeding tube placement,ENFTP)行肠内营养(enteral nutrition,EN)与全胃肠外营养(total parenteral nutrition,TPN)的临床疗效.方法 选择胃窦癌伴胃窦腔或幽门梗阻患者行ENFTP的患者共100例,选取同期行TPN治疗的患者50例,分别观察两组在营养支持后1、2周的血红蛋白、血清白蛋白、血脂、体重等营养指标,平均住院天数,营养支持平均每日费用,并发症的发生率及营养支持后能耐受化疗或手术的例数.结果 营养支持后1周,ENFTP组的营养指标无明显变化(均P ＞0.05).TPN组的血红蛋白、肌酐及体重较治疗前有进一步下降(均P＜0.05).营养支持后2周,ENFTP组血清总蛋白及白蛋白较治疗前升高明显(P＜0.05),而TPN组在血红蛋白、血肌酐、血清白蛋白较治疗前下降明显,与ENFTP组比差异有统计学意义(P＜0.05).两组其他营养指标在营养支持后2周差异无统计学意义(P ＞0.05).ENFTP组在平均住院日、营养支持平均每日费用、并发症的发生率方面均低于TPN组(P＜0.05).ENFTP组与TPN组在营养支持后耐受手术或化疗的例数无明显差异(P ＞0.05).结论 胃窦癌伴胃窦腔或幽门梗阻患者ENFTP较TPN更能有效的维持或改善其营养状况,并缩短患者的住院天数,减少住院费用,提高患者的生存质量.经胃镜放置空肠营养管在胃窦癌伴胃窦腔或幽门梗阻患者中的使用是简便快捷、安全有效的,值得临床推广.%Objective To evaluate the application of endoscopically nasojejunal feeding tube placement (ENFTP) for enteral nutrition (EN) in gastric cancer patients with antrum or pyloric obstruction. Methods One hundred and fifty gastric cancer patients with antrum or pyloric obstruction received ENFTP EN (n=100) or total parenteral nutrition (TPN, n=50). Hemoglobin, serum albumin, blood lipids, weight and other nutrition indicators were measured after one or two weeks for nutritional support. Meanwhile,an average length of hospital stay, the average daily cost, the incidence rate of complications and the number of patients tolerating chemotherapy or surgery after nutritional support were also measured. Results After one week of nutritional support, nutrition indicators in the ENFTP EN group showed no significant changes (P >0.05), while the value of hemoglobin, creatinine and weight were decreased in TPN group (P<0.05). After two weeks of nutritional support, the value of serum total protein and albumin in ENFTP group were increased significantly (P<0.05), while those were significantly decreased in TPN group (P<0.05). Other nutritional indicators were not significantly changed in both groups (P >0.05). Compared with TPN group, the length of hospital stay, the average daily cost and the incidence rate of complications were significant lower in the ENFTP group (P<0.05). There was no significant difference in the number of patients tolerating chemotherapy or surgery after nutritional support between two groups (P >0.05). Conclusion The ENFTP can improve nutritional status and reduce the hospital stay and hospitalization costs, and improve the quality of life for gastric cancer patients with antrum or pyloric obstruction. Endoscopically nasojejunal feeding tube placement is safe and effective approach for gastric cancer patients with antrum or pyloric obstruction.
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