Effect Of Postoperative Early Enteral Nutrition On Immunologic Function In Elderly Gastric Cancer Patients After Total Gastrectomy

Objective:To evaluate the safety of early enteral nutrition and the effect of early enteral nutrition on postoperative nutritional status and immunologic function in the old patients with gastric cancer after total gastrectomy。Methods:66 cases of elderly gastric cancer patients who underwent the same elective operation for total gastrectomy were prospectively randomized into two groups (33 cases in each group ),an early enteral nutrition (EEN) group who received jejunostoma tube infusion with Nutrison from postoperative day and a parenteral nutrition (PN) group who received isocaloric and isonitrogenous nutritional formulas with EEN group on the same postoperative day with the nutritional goal 125 kcal/kg/day. Liver function parameters and immune status in the blood were measured in both groups preoperatively,on the first day and the tenth day postoperatively . nutritional parameters such as Serum total protein,Albumin,Prealbumin,Transferrin,IL-2 parameters were evaluated.Peripheral lymphocyte subpopulation,Natural killer (NK) cell activity and immunoglublin levels were also measured.The measurement data were analyzed with SPSS 13.0 For Windows software。Results:The differences in the occur of serious complication showed above were no significant in two groups before operation。Patients in the EEN group tolerated enteral feeding well. The incidence of side effects of the exteral nutrition was 69.70% (23/33)in the EN group,while 72.72% (24/33)in the PN group, but generally mild。All the serum protein parameters decreased significantly on the first day after operation and recovered gradually on the tenth day after operation. On the tenth day after operation, serum PAB and TRF levels in the EN group were significant higher than in the PN group(P<0.05)。IL-2 in serum was significantly lower on the first day after operation in both groups (P<0.05 )。However,higher on the tenth day after operation than on the first day after operation in the EN group. No significant changes of T lymphocyte subset parameters were observed in both groups,Activity of NK lymphocyte decreased significantly after operation,But there was no significant difference between the two groups. Serum IgG,IgA and IgM levels were decreased slightly on the first day after operation on the tenth day after operation IgG and IgM levels were significantly higher in the EN group。Conclusions:Early enteral nutrition via jejunostoma tube infusion is safe,well tolerated and price is low after total gastrectomy in elderly patients,EEN may attenuate the impairment of hepatic function after operation and provide better resume of hepatic protein synthesis,Early enteral nutrition may have beneficial effects on the early recovery of immunologic function in elderly patients with total gastrectomy,Elderly patients with total gastrectomy might benefit the most from early enteral nutrition。...