Clinical Study Of Early Postoperative Enteral And Parenteral Parenteral Nutritionafter Splencetomy With Periesophagogastric Devascularization

Objective To investigate and compare the efficacy and advantages of enteral nutrition and parenteral nutrition support after splenectomy and pericardial vascular decompression in cirrhotic portal hypertension.Methods 135 patients admitted to the Department of Hepatobiliary Surgery,Union Hospital of Tongji Medical College,Huazhong University of Science and Technology from August 2015 to February 2018 diagnosed as portal hypertension(Hypersplenism and esophageal varices)due to post-hepatitis cirrhosis and received pericardial vascular dissection surgery were included in this retrospective analysis.They were divided into the enteral nutrition group,parenteral nutrition group and normal control group according to statistical randomized grouping method.Enteral nutrition,parenteral nutrition and ordinary glucose nutritional support therapy were given to each group from the first day after operation.All patient’s liver function,immune function,nutritional status and other parameters before and after surgery were observed,their changes were compared and statistically analyzed between each group.Results The index of postoperative nutritional status in EN group was ALB [40.2±7.8] g/L,TRF [2.3±0.4] g/L,the index of postoperative nutritional status of PN group was ALB [40.7±6.6] g/L,TRF [2.26±0.35] g/L,nutritional status indexes of both groups were significantly higher than preoperative and control groups(P<0.05),but there was no significant difference between EN and PN groups(P>0.05).The liver function parameters of postoperative PN group were ALT [56.74±5.8] U/L,TBIL [26.46±7.7] μmol/L,which was significantly higher than that of EN group ALT [39.86±5.0] U/L,TBIL [19.22±4.1] μmol/L(P<0.05),and there was no significant difference between the EN group and the control group(P>0.05).In the EN group and the PN group,the immune function at the 8th day after operation significantly improved compared with the preoperative and control group,but there was no significant difference between EN and PN groups(P>0.05).The postoperative peritoneal infection rate in the PN group [11.76(6/5)] was significantly higher than that in the EN group [1.85(1/54)](P<0.05).The infection risk in the EN group was significantly lower than that in the control group [10.00(3/30)],intestinal resident pathogenic bacteria were the main infecting flora.Conclusion 1.Early postoperative enteral nutrition is a safe and effective nutritional support for postoperative patients with portal hypertension,and the effect is better than parenteral nutrition.2.Early postoperative enteral nutrition support treatment for portal hypertension can reduce the postoperative intra-abdominal infection rate.3.Enteral nutrition support treatment can reduce postoperative liver load and improve liver function reserve in the long term,which is of great significance in improving liver function.4.Nutrition support treatment can improve the immune function in patients with portal hypertension after surgery.