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山东大学学报 (医学版) ›› 2020, Vol. 1 ›› Issue (7): 77-81.doi: 10.6040/j.issn.1671-7554.0.2019.1247

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腔镜下细针导管空肠造瘘在微创McKeown食管癌切除术中的应用

吕龙飞,李林,李树海,亓磊,鲁铭,程传乐,田辉   

  1. 山东大学齐鲁医院胸外科, 山东 济南 250012
  • 出版日期:2020-07-20 发布日期:2020-07-10
  • 通讯作者: 田辉. E-mail:tianhuiql@126.com
  • 基金资助:
    国家自然科学基金(81672292);泰山学者工程专项经费资助(NOts201712087)

Application of laparoscopic fine needle catheter jejunostomy in minimally invasive McKeown resection of esophageal cancer

LYU Longfei, LI Lin, LI Shuhai, QI Lei, LU Ming, CHENG Chuanle, TIAN Hui   

  1. Department of Thoracic Surgery, Qilu Hospital, Cheloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Online:2020-07-20 Published:2020-07-10

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摘要： 目的 分析腔镜下细针导管空肠造瘘的操作方法,探讨其在微创McKeown食管癌切除术中的应用效果。 方法 收集2010年1月至2017年12月山东大学齐鲁医院单一手术团队完成的1 023例微创McKeown食管癌切除术患者的临床资料,回顾性分析术中腔镜下细针导管空肠造瘘的完成情况,及术后造瘘管口渗液、造瘘管管腔堵塞、肠梗阻等造瘘相关并发症的发生率。 结果 1 023例患者均在腔镜下顺利完成细针导管空肠造瘘,平均手术时间(14.77±2.99)min,平均出血量(2.87±0.96)mL;有9例(0.88%)患者出现空肠造瘘相关并发症,其中造瘘管口渗液3例(改行肠外营养支持,及时换药,保持造瘘口周围皮肤清洁,局部涂抹氧化锌软膏)、造瘘管管腔堵塞3例(经口进食前行肠外营养支持)、空肠瘘1例(行2次手术)、肠系膜扭转1例(行2次手术)、不完全肠梗阻1例(行保守治疗)。 结论 微创McKeown食管癌切除术中行腔镜下细针导管空肠造瘘,操作简便、安全可行,是建立术后早期肠内营养的有效途径,值得临床推广应用。

关键词: 细针导管, 空肠造瘘, 微创, McKeown, 食管癌

Abstract: Objective To analyze the operative methods of laparoscopic fine needle catheter jejunostomy, and to investigate its application effects in minimally invasive McKeown resection of esophageal cancer. Methods Clinical data of 1 023 cases undergoing minimally invasive McKeown resection of esophageal cancer by single-operation group were collected from January 2010 to December 2017. The performance of fine needle catheter jejunostomy under laparoscopy, and the incidence of complications related to jejunostomy, such as postoperative catheter site fistula, tube obstruction, intestinal obstruction and so on, were retrospectively analyzed. Results The fine needle catheter jejunostomy were successfully completed in all patients under laparoscopy, and the average operating time was(14.77±2.99)minutes,the mean bleeding volume was(2.87±0.96)mL. The complications related to jejunostomy occurred in 9 cases(0.88%), of which, 3 cases with catheter site fistula(the enteral nutrition was changed to parenteral nutrition, the dressing was changed in time, the skin around the stoma was kept clean, and zinc oxide ointment was applied locally), 3 cases with tube obstruction(parenteral nutrition support was performed before oral feeding), 1 case with jejunal fistula(a second operation was performed), 1 case with mesenteric torsion(a second operation was performed), and 1 case with incomplete intestinal obstruction(the conservative therapy was performed). Conclusion The laparascopic fine needle catheter jejunostomy is an effective approach to establish postoperative enteral nutrition for patients undergoing minimally invasive McKeown resection of esophageal cancer. The method is simple and convenient, safe and feasible, so worthy of clinical application.

Key words: Fine needle catheter, Jejunostomy, Minimally invasive, McKeown, Esophageal cancer

中图分类号: 

  • R615
[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[2] 李印, 孙海波. 食管癌加速康复外科治疗的进展及展望[J].中华胸部外科电子杂志, 2017, 4(3): 140-148. LI Yin, SUN Haibo. Progress and prospect of enhanced recovery after surgery for esophageal cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2017, 4(3): 140-148.
[3] Zhao Y, Mao Y. [Advancement of minimally invasive esophagectomy] [J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2018, 21(1): 112-117.
[4] Sun HB, Li Y, Liu XB, et al. Early oral feeding following McKeown minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial[J]. Ann Surg, 2018, 267(3): 435-442.
[5] 亓磊, 田辉, 李林, 等. 微创食管癌切除术后淋巴结转移规律及预后分析[J].中华腔镜外科杂志(电子版), 2018, 11(2): 98-102. QI Lei, TIAN Hui, LI Lin, et al. Clinicopathological features of lymph node metastasis and prognostic factors in esophageal cancer treated with minimally invasive esophagectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(2): 98-102.
[6] 陈双喜. 食管癌根治术后经空肠造瘘管肠内营养对免疫应答、肠黏膜屏障功能的影响[J]. 海南医学院学报, 2017, 23(24): 3411-3414. CHEN Shuangxi. Effects of enteral nutrition via jejunostomy catheter on immune response and intestinal muco-sal barrier function after radical operation for esophageal cancer[J]. Journal of Hainan Medical University, 2017, 23(24): 3411-3414.
[7] Steenhagen E, van Vulpen JK, van Hillegersberg R, et al. Nutrition in peri-operative esophageal cancer management[J]. Expert Rev Gastroenterol Hepatol, 2017, 11(7): 663-672.
[8] Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults[J]. Clin Nutr, 2016, 35(2): 247-307.
[9] Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: society of critical care medicine(SCCM)and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.)[J]. Crit Care Med, 2016, 44(2): 390-438.
[10] 王总飞, 李印, 郑燕, 等. 食管癌腔镜术后营养途径的选择[J].中国肿瘤临床, 2014, 41(23): 1490-1494. WANG Zongfei, LI Yin, ZHENG Yan, et al. Selection of nutrition routes for patients with esophageal cancer undergoing thoracolaparoscopic esophagectomy[J]. Chinese Journal of Clinical Oncology, 2014, 41(23): 1490-1494.
[11] 周健, 赵辉, 曹家顺, 等. 腹腔镜细针导管空肠造瘘术在食管癌根治术中的应用[J].中国内镜杂志, 2015, 21(9): 971-973. ZHOU Jian, ZHAO Hui, CAO Jiashun, et al. Application of laparascopic fine-needle catheter jejunostomy in radical resection of esophageal carcinoma[J]. China Journal of Endoscopy, 2015, 21(9):971-973.
[12] de Aguilar-Nascimento JE, Bicudo-Salomao A, Portari-Filho PE. Optimal timing for the initiation of enteral and parenteral nutrition in critical medical and surgical conditions[J]. Nutrition, 2012, 28(9): 840-843.
[13] 纪勇, 陈静瑜, 郑明峰, 等. 食管癌病人术后早期肠内营养的临床应用[J].肠外与肠内营养, 2012, 19(1): 21-23. JI Yong, CHEN Jingyu, ZHENG Mingfeng, et al. Clinical research on early postoperative enteral nutrition in patients with esophageal cancer[J]. Parenteral Enteral Nutrition, 2012, 19(1): 21-23.
[14] Mabvuure NT, Roman A, Roman I, et al. Enteral immunonutrition versus standard enteral nutrition for patients undergoing oesophagogastric resection for cancer[J]. Int J Surg, 2013, 11(2): 122-127.
[15] 朱维铭. 肠内营养的规范化问题[J]. 肠外与肠内营养, 2013, 20(4): 193-195.
[16] 龙晓静, 孙德强, 曾英, 等. 食管癌术后早期肠内营养联合肠外营养与全肠外营养支持的临床疗效比较[J].中国医药导报, 2016, 13(5): 126-129. LONG Xiaojing, SUN Deqiang, ZENG Ying, et al. Effect comparison of combined application of enteral nutrition and parenteral nutrition with TPN in patients after esophageal cancer surgery [J]. China Medical Herald, 2016, 13(5): 126-129.
[17] 朱小平, 王燕, 何慧娟. 肠内营养与肠外营养对放疗食管癌患者的营养改善效果研究[J]. 中国药物与临床, 2019, 19(15): 2590-2592.
[18] Peng J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis[J]. Dis Esophagus, 2016, 29(4): 333-341.
[19] 陆小月, 羌燕, 李晓旭, 等. 两种不同肠内营养管置管法在食管癌术后营养治疗中的应用观察[J]. 中国肿瘤外科杂志, 2017, 9(6): 405-407.
[20] 赵松, 吴彬, 齐宇, 等. 空肠造瘘营养管与鼻空肠营养管在食管癌根治术中的应用[J]. 中国老年学杂志, 2014, 10(34): 2740-2741.
[21] 杨娟, 黄楚, 李林. 胸腹腔镜联合食管癌根治术后空肠造瘘管营养支持90例效果观察[J]. 齐鲁护理杂志, 2016, 22(2): 66-68.
[22] Zhaosheng Jin, Tong J. Gan. 加速康复临床路径优化:未来的发展方向[J]. 协和医学杂志, 2019, 10(6): 553-556. Zhaosheng Jin, Tong J. Gan. Enhanced recovery pathways: the direction in the future[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 553-556.
[23] 中国医师协会胸外科分会快速康复专家委员会, 王天佑, 李印. 食管癌加速康复外科技术应用专家共识(2016版)[J]. 中华胸心血管外科杂志, 2016, 32(12): 717-722. ERAS Expert Committee of CATS, WANG Tianyou, LI Yin. Chinese Experts Consensus on Enhanced Recovery After Esophagectomy(Vision 2016)[J]. Chinese Journal of Thoracic and Cardiovascular Surgery, 2016, 32(12): 717-722.
[24] 王新颖, 牛程麟, 黄迎春, 等. 单中心家庭肠内营养支持应用情况分析[J]. 肠外与肠内营养, 2011, 18(4): 200-202, 206. WANG Xinying, NIU Chenglin, HUANG Yingchun, et al. Clinical experience of patients with home enteral nutrition in a single center of China[J]. Parenteral Enteral Nutrition, 2011, 18(4):200-202, 206.
[25] 孔筠, 韩璐, 王晶, 等. 家庭肠内营养患者营养支持效果研究[J]. 中国医药, 2013, 8(9): 1312-1314. KONG Yun, HAN Lu, WANG Jing, et al. Effect of nutritional support of 24 patients with home enteral nutrition[J]. China Medicine, 2013, 8(9): 1312-1314.
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