关键词: 肠道营养, 食管肿瘤, 化学疗法, 辅助, 多不饱和脂肪酸酰胺类, 精氨酸

Abstract: Abstract: Objective To evaluate the nutritional status, immune function and clinical effectiveness of early enteral immunonutrition in patients of esophageal cancer before operation. Methods Sixty-five patients received totally esophagectomy were enrolled in this randomized controlled trial. The patients were randomly divided into enteral immunonutrition group (EIN group, n=34) and regular diet group (control group, n=31). All patients underwent neoadjuvant chemotherapy for 2 cycles before surgery, and patients underwent totally esophagectomy after finishing neoadjuvant chemotherapy for 3 to 4 weeks. The EIN group was given oral enteral immunonutrition on the basis of regular diet at the 7th day after the end of the second course of neoadjuvant chemotherapy until one day before surgery. The control group was given the regular diet after the end of the second course of neoadjuvant chemotherapy. Data of body mass index, triceps skin wrinkle thickness and upper arm circumference were compared one week after the end of the second course of neoadjuvant chemotherapy and 1 day before surgery between two groups. The levels of nutritional indexes and immune indexes were compared one week after the second course of neoadjuvant chemotherapy, one day before surgery and one day, one week after surgery between two groups. The number of getting out of bed, postoperative enteral nutrition-related side effects, postoperative pneumonia complications, the time of first postoperative anal exhaust and the length of hospitalization were also compared between the two groups. Results There were no significant differences in gender, age, tobacco smoking, drinking, tumor location and clinical stage between the two groups (P＞0.05). There were significant differences in the body mass index, triceps skin wrinkle thickness and upper arm circumference on the first day before operation between the two groups (P＜0.05). The nutritional indexes and immune indexes increased significantly one day before surgery in EIN group (P＜0.05). The nutritional indexes and immune indexes were significantly decreased on the first day after surgery in two groups, which was statistically significant compared with those of the first day before surgery (P＜0.05). On the one week after the operation, the indicators of the two groups were significantly increased compared with those of the 1st day after the operation (P＜0.05). There were significant differences in the above indicators and immune indexes one week after the operation in two groups (P＜0.05). The number of patients with getting out of bed after operation was significantly higher in the EIN group than that in the control group. The number of patients with postoperative enteral nutrition related adverse reactions (abdominal distention and diarrhea) and complications of pneumonia were less in the EIN group than those in the control group. The time of first exhaust and hospitalization was significantly shorter in the EIN group than that in the control group (P＜0.05). Conclusion The early enteral immunonutrition before surgery can improve the nutritional status and immune status, increase the patient's tolerance to surgery, reduce the occurrence of complications, and promote rapid recovery in patients after neoadjuvant chemotherapy.

Key words: enteral nutrition, esophageal neoplasms, chemotherapy, adjuvant, polyunsaturated alkamides, arginine