胃全摘術後の栄養管理

特に経腸栄養の有用性について

抄録

A large number of reports have dealt with comparative studies of total parenteral nutrition (TPN) and enteral hyperarimentation (EH) . However, there have been few reports on comparative studies in which patients were stringently selected for identical observation periods.
We divided patients who underwent total gastrectomy fer stomach carcinoma into two groups. The two groups were given TPN and EH, respectively, for three weeks te investigate immunolagical competence and untritional conditions. There were ten patients in the TPN group and ten in the EH group was IgG, IgA, IgM, and complements (C₃ and CH₅₀) selected as the immunological indices. At the same time, TP, Alb, Tf, PA and RBP were used as the nutritional indices. Immunological competence dropped from one to three days after surgery in both groups, but gradually increased thereafter. Up to three weeks after surgery, immunological indices showed preoperative values or above though there were no significant differences between the two groups. The nutritional indices were low from three to four days after surgery but gradually increased thereafter and returned to preoperative levels or above, no significant differences were noted between the two groups. This was probably because malignant tumors were resected, and nutrition was supplemented from three to four days after surgery which led to the improvement of immunological and nutritional indices. Since the patients in both groups experienced uneventful clinical courses without developing any complications, there were no significant differences in these indices between the two groups.
Some investigators recommend the prioritized use of TPN because no differences have been observed in immunological competence and nutritional conditions after performing TPN or EH for nutritional management following surgery on the digestive tract. On the basis of the above-mentioned findings, however, we believe that EH should be used more frequently since it is physiological and easy to perform, and does not result in any serious complications.