【摘要】 目的 分析围术期阶梯式肠内外联合营养管理应用于行腹腔镜下囊肿切除联合空肠Roux-Y吻合术胆总管囊肿患儿的效果,以期为临床决策的制定提供参考。方法 纳入徐州市儿童医院普外科2020年6月—2024年6月收治的80例胆总管囊肿患儿,开展前瞻性对照研究。采用随机数字表法,将80例患儿分为观察组(n=40)和对照组(n=40)。2组患儿均接受腹腔镜下囊肿切除联合空肠Roux-Y吻合术治疗及常规围术期管理,对照组患儿术后行肠外营养支持,观察组患儿加用围术期阶梯式肠内外联合营养管理。对比2组患儿手术情况、术后恢复情况、并发症发生率,以及术前、术后(术后第7天)营养状态[白蛋白(ALB)、前白蛋白(PA)、视黄醇结合蛋白(RBP)、血红蛋白(Hb)]、炎症指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)]变化情况。结果 2组患儿手术时间、术中出血量比较,差异均无统计学意义(P>0.05),且2组患儿术中均无中转开腹者。观察组患儿胃肠功能恢复时间、引流管拔除时间、总住院时间均较对照组更短(P<0.05)。观察组患儿术后并发症发生率为2.5%,低于对照组的7.5%,但差异无统计学意义(P>0.05)。术后,2组患儿ALB、PA、RBP水平均较术前下降(P<0.05),但观察组患儿术后ALB、PA、RBP水平均较对照组更高(P<0.05)。术后,2组患儿CRP、IL-6、IL-8水平均较术前升高(P<0.05),但观察组患儿术后CRP、IL-6、IL-8水平均较对照组更低(P<0.05)。结论 围术期阶梯式肠内外联合营养管理应用于行腹腔镜下囊肿切除联合空肠Roux-Y吻合术胆总管囊肿患儿,能够促进患儿术后恢复,并减轻手术刺激所致营养状态和炎症指标的波动,值得推广应用。更多还原

【Abstract】 Objective To evaluate the effects of perioperative stepwise combined enteral and parenteral nutrition management in children with choledochal cysts undergoing laparoscopic cyst excision combined with jejunal Roux-en-Y anastomosis, and to provide evidence for clinical decision-making. Methods In this prospective controlled study, 80 children treated for choledochal cysts in the Department of General Surgery at Xuzhou Children’s Hospital from June 2020 to June 2024 were randomized into an observation group(n=40) and a control group(n=40) using a random number table. Both groups underwent laparoscopic cyst excision with jejunal Roux-en-Y anastomosis and routine perioperative care. Postoperatively, the control group received parenteral nutrition alone, while the observation group received stepwise combined enteral and parenteral nutrition management. Surgical parameters, postoperative recovery, complication rates, and pre-and postoperative(day 7) nutritional status(serum albumin [ALB], prealbumin [PA], retinol-binding protein [RBP], hemoglobin [Hb]) and inflammatory markers(C-reactive protein [CRP], interleukin-6 [IL-6], interleukin-8 [IL-8]) were compared between the two groups. Results No significant differences between the two groups were noted in operative time or intraoperative blood loss(P>0.05). No cases required conversion to open surgery. The observation group experienced shorter times to gastrointestinal function recovery, earlier removal of drainage tubes, and reduced total length of hospital stay compared with the control group(P<0.05). The overall postoperative complication rate was 2.5% in the observation group and 7.5% in the control group, without a significant difference(P>0.05). After surgery, both groups showed declines in ALB, PA, and RBP levels compared with preoperative values(P<0.05), but the observation group maintained significantly higher ALB, PA, and RBP levels than the control group(P<0.05). Postoperatively, CRP, IL-6, and IL-8 levels rose in both groups compared with preoperative levels(P<0.05); however, the observation group’s postoperative CRP, IL-6, and IL-8 levels were significantly lower than those of the control group(P<0.05). Conclusion Perioperative stepwise combined enteral and parenteral nutrition management in children receiving laparoscopic choledochal cyst excision with jejunal Roux-en-Y anastomosis promotes postoperative recovery and attenuates fluctuations in nutritional and inflammatory parameters induced by surgical stress. This approach merits wider promotion and application.更多还原