| ObjectivesAfter conventional surgery of maxillofacial malignancies,a large area of the maxillofacial structures and tissues will be lost,which will lead to the loss of basic eating ability,and seriously affect their quality of life and mental health.The reconstruction of mandibular defects with fibular flap is at the historic moment.It is an ideal operative method at present.However,the postoperative nutrition support therapy still stays in the traditional enteral nutrition nasal feeding.Our objective was to compare the effects of parenteral nutrition combined with enteral nutrition(PN + EN),total enteral nutrition(TEN)and total parenteral nutrition(TPN)in patients undergoing peroneal musculocutaneous flap transplantation,and improve the traditional nutrition of patients with malignant tumor of maxillofacial tumor.MethodsThere were 72 patients with maxillofacial malignancy treated by the Department of Maxillofacial Surgery at Tianjin Stomatological Hospital between March 2015 and December 2017.The operation often involves jaw and tumor resection,neck dissection,peroneal musculocutaneous flap preparation,and peroneal musculocutaneous flap transfer repair.Three types of nutritional support:(1)Group A(receiving PN + EN): after Charcot-Marie-flap surgery to the head,the head was kept absolutely still for 1 to 3 days.Between one and three days postoperatively,we gave PN.PN + EN Group was given 4 days after the operation,and the proportion of PN was decreased gradually.We gave PN Group: (16-20)kcal/(kg?d),with a glucose-to-lipid ratio of 6:4 or 5:5,calorie-to-nitrogen ratio(120-150):1 and according to the needs of the patient to supplement a variety of trace elements and electrolytes,dynamically adjust the proportion of insulin,usually with a glucose-to-insulin ratio of(8-10):1 g/U.If the patients had diabetes,the glucose-to-insulin ratio was(4-5):1 g/U.We gave EN Group: the dosage of EN was the standard(20-25)kcal/(kg?d),and the drip rate was 50 ml/h.If no reflux,diarrhea,abdominal distension,or other gastrointestinal side effects occurred,2 to 3 days later we injected EN continuously at a drip rate of 100ml/h.(2)Group B(receiving TEN): throughout the postsurgical period,a high-energy nutrient mixture(1kcal/ml,Nedicia)was administered via continuous drip through a nasal feeding tube.(3)Group C(receiving TPN): after the operation,1-7d was given to PN,and then the heat was gradually increased according to the patient’s condition.The biochemical indices of the three groups before and after surgery in the three groups,length of hospital stay,physical assessments,and psychological assessments were observed and compared.ResultsThere were no significant differences in the biochemical indices of the three groups prior to their operations(P>0.05).All of the biochemical indices decreased after surgery in the three groups.The biochemical indices of Group A(PN + EN)were significantly higher than those of the other two groups,except for sodium and potassium levels.There was a significant difference in length of hospital stay between the three groups(P<0.05),with the length of stay being shortest in Group A(PN + EN),and postoperative nutritional status was better than that of the other two groups.The SFMST score of the psychological assessment showed that patients in Group C had a better psychological status during the treatment.ConclusionsParenteral nutrition combined with enteral nutrition can shorten the hospitalization time and improve the prognosis after peroneal musculocutaneous flap transplantation.On the basis of our results,the best method of nutritional supplementation for patients after peroneal musculocutaneous flap transplantation is via combined parenteral and enteral nutrition.After 1 to 3 days,supplementary parenteral nutrition should be given,then enteral nutrition should be added while gradually reducing parenteral nutrition.Finally,a transition should be made to full enteral nutrition with oral intake,in order to safely and effectively shorten the recovery period. |
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