Клінічна хірургія (Dec 2019)
Early peroral feeding after pancreaticoduodenecomy
Abstract
Objective. To analyze the various ways for enteral feeding after pancreaticoduodenectomy. Materials and methods. There were investigated the results of pancreaticoduodenectomy, performed in 78 patients, suffering tumors of pancreatic head and periampullary zone, in whom various methods of nutritive support, in 2003 - 2017 yrs were applied. For comparative analysis the patients were divided into two groups: the first - 39 patients, perioperative treatment of whom was conducted in accordance to the ERAS program, and the second - 39 patients, who were treated using a standard method. In patients of the first group the effects of a peroral way of nutrition were compared, as well as combined peroral and enteral nutrition via microjejunostomy. There were studied the terms of restoration of peroral feeding, the gastrostasis rate, the nutrition calorage during 7 postoperative days, levels of general protein and albumin on the first, third and seventh postoperative day. Results. In 33 (84.6%) patients of the first group the peroral nutrition restoration have occurred in complete order to the protocol. The gastrostasis rate in patients of the first group was essentially lesser, than in patients of the second group. In the first group this complication have occurred in 6 (15.4%) patients, in the second group - in 14 (35.9%) patients (p = 0.009). Dynamics of level of general protein and albumin of the blood in postoperative period did not depend on method and energetic estimate of the nutrition. Conclusion. Application of peroral feeding, in accordance to the concept of the program for accelerated restoration of the patients, survived after pancreaticododenectomy, constitutes an optimal way for the nutrient support of an organism and permits to reduce the gastrostasis rate trustworthily.
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