背景:肠内营养是食管切除术后的首选营养方式。然而,肠内营养的首选模式(喂养空肠造口术(FJ)与鼻空肠(NJ)管)仍有争议。在这项随机对照试验(RCT)中,我们在安全性方面比较了FJ和NJ管喂养,可行性,功效,和生活质量(QOL)参数在印度患者中接受经食管食管切除术(THE)的食管癌。
方法:这种单中心,双臂(FJ和NJ管),非劣效性RCT于2020年3月至2024年1月进行。48例患者接受了后纵隔胃拉拔术,并被随机分配到NJ和FJ组(每组24例)。术后并发症,导管功效,随访6周,比较两组患者的生活质量指标。
结果:在此RCT中,我们发现导管相关并发症的发生率没有显着差异,术后并发症发生率,导管功效,NJ管和FJ管患者的视觉模拟疼痛评分,以下为食道癌。在NJ组中,自我报告的物理领域QOL得分明显更好,均在放电时(44.7±6.2vs39.8+5.6;p值,0.005)和6周随访(55.4±5.2vs48.6±4.5;p值,<0.001)。
结论:根据我们RCT的发现,我们得出的结论是,两种肠内进入方法(新泽西州与FJ)显示导管相关并发症的发生率相当。使用NJ管是手术FJ的可行替代方案,有早期去除的好处,并节省了与每个腹部一根管子相关的痛苦。
BACKGROUND: Enteral nutrition is the preferred mode of nutrition following esophagectomy. However, the preferred mode of enteral nutrition (feeding jejunostomy (FJ) vs. nasojejunal (NJ) tube) remains contentious. In this randomized controlled trial (RCT), we compared FJ with NJ tube feeding in terms of safety, feasibility, efficacy, and quality-of-life (QOL) parameters in Indian patients undergoing trans-hiatal esophagectomy (THE) for carcinoma esophagus.
METHODS: This single-center, two-armed (FJ and NJ tube), non-inferiority RCT was conducted from March 2020 to January 2024. Forty-eight patients underwent THE with posterior-mediastinal-gastric pull-up and were randomized to NJ and FJ arms (24 in each group). The postoperative complications, catheter efficacy, and QOL parameters were compared between the two groups till the 6-week follow-up.
RESULTS: In this RCT, we found no significant difference in the occurrence of catheter-related complications, postoperative complication rate, catheter efficacy, and visual analog pain scores between patients with NJ tube and FJ, following THE for esophageal cancer. There was a significantly better self-reported physical domain QOL score noted in the NJ group, both at the time of discharge (44.7 ± 6.2 vs 39.8 + 5.6; p value, 0.005) and at the 6-week follow-up (55.4 ± 5.2 vs 48.6 ± 4.5; p value, < 0.001).
CONCLUSIONS: Based on the findings of our RCT, we conclude that both enteral access methods (NJ vs. FJ) exhibit comparable incidences of catheter-related complications. The use of NJ tube is a viable alternative to a surgical FJ, has the benefit of early removal, and saves the distress associated with a tube per abdomen.