Objective: To investigate the clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Methods: A total of 379 HCC patients who received partial hepatectomy from January 2010 to December 2013 in Department of Hepatobiliary Surgery of Cancer Hospital, Chinese Academy of Medical Sciences were selected. Based on the nutritional method, all of the enrolled patients were divided into two group: 142 patients who received early enteral nutrition (EEN) combined with parenteral nutrition (PN) were identified as EEN+ PN group; 237 patients who received total parenteral nutrition (TPN) were identified as TPN group. These two groups were even divided into two subgroups, centrally located HCC (cl-HCC) and non-centrally located HCC (ncl-HCC). The clinical effectiveness of different groups was assessed and compared. Results: The age, gender, body mass index (BMI), the maximum diameter of the tumor, the amount of operative bleeding and postoperative infective rate did not show statistically significant differences between EEN+ PN group and TPN group (P>0.05). On the seventh postoperative day (7(th) POD), aspartate transaminase (AST) of EEN+ PN group and TPN group were (41.6±2.0) IU/L and (50.4±3.2) IU/L respectively, and the difference was statistically significant (P<0.05). Alkaline phosphatase (ALP) of these two groups were (80.8±2.4) IU/L and (90.2±2.3) IU/L, respectively, and the difference was statistically significant (P<0.05). Total bilirubin (TBIL) of these two groups were (15.8±0.7) μmol/L and (19.1±0.7) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7(th) POD, AST in cl-HCC subgroups of EEN+ PN group and TPN group were (39.6±2.6) IU/L and (61.0±7.0) IU/L, respectively, and the difference was statistically significant (P<0.05). TBIL in cl-HCC subgroups of these two groups were (14.4±0.9) μmol/L and (20.7±1.3) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7(th) POD, ALP in ncl-HCC subgroups of these two groups were (79.3±3.0) IU/L and (89.9±3.1) IU/L, respectively, and the difference was statistically significant (P<0.05). The total length of stay (t-LOS) of these two groups were (15.8±0.4) days and (17.1±0.4) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) of these two groups were (8.6±0.2) days and (10.1±0.3) days, respectively, and the difference was statistically significant (P<0.05). Total length of stay (t-LOS) in ncl-HCC subgroups of these two groups were (15.1±0.5) days and (16.6±0.3) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in ncl-HCC subgroups of these two groups were (8.4±0.2) days and (9.5±0.2) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in cl-HCC subgroups of these two groups were (8.7±0.2) days and (11.0±0.8) days, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses of these two groups were (20 855.0±549.8) yuan and (23 373.0±715.5) yuan, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses in cl-HCC subgroups of these two groups were (21 012.0±748.5) yuan and (24 697.0±1 409.0) yuan, respectively, and the difference was statistically significant (P<0.05). Conclusion: EEN+ PN can improve the liver function, shorten the postoperative hospitalization time and reduce the postoperative hospitalization expenses of HCC patients in need of nutritional support.
目的： 探讨不同营养支持方法对肝细胞癌(HCC)肝部分切除术后的疗效。 方法： 选择2010年1月至2013年12月就诊于中国医学科学院肿瘤医院的379例HCC肝部分切除术后患者，按营养支持方法分为术后早期肠内营养支持(EEN)＋肠外营养支持(PN)组和全胃肠外营养支持(TPN)组。其中EEN＋PN组142例，术后连续4 d使用EEN联合PN；TPN组237例，术后连续4 d使用TPN。EEN＋PN组和TPN组再分为2个亚组，即中央型HCC(cl－HCC)亚组和周围型HCC(ncl－HCC)亚组。分析不同营养支持方法对EEN＋PN组和TPN组及其亚组患者的疗效。 结果： EEN＋PN组和TPN组及其亚组患者的性别、年龄、体质指数、肿瘤大小、术中出血量、术后并发症发生率和术后感染率差异均无统计学意义(均P>0.05)。术后第7天，EEN＋PN组和TPN组患者的门冬氨酸氨基转移酶(AST)分别为(41.6±2.0)IU/L和(50.4±3.2)IU/L，碱性磷酸酶(ALP)分别为(80.8±2.4)IU/L和(90.2±2.3)IU/L，总胆红素(TBIL)分别为(15.8±0.7)μmol/L和(19.1±0.7)μmol/L，差异均有统计学意义(均P<0.05)。术后第7天，EEN＋PN组和TPN组中cl－HCC亚组患者的AST分别为(39.6±2.6)IU/L和(61.0±7.0)IU/L，TBIL分别为(14.4±0.9)μmol/L和(20.7±1.3)μmol/L，差异均有统计学意义(均P<0.05)。术后第7天，EEN＋PN组和TPN组中ncl－HCC亚组患者的ALP分别为(79.3±3.0)IU/L和(89.9±3.1)IU/L，差异有统计学意义(P<0.05)。EEN＋PN组和TPN组患者的总住院时间分别为(15.8±0.4)d和(17.1±0.4)d，，术后住院时间分别为(8.6±0.2)d和(10.1±0.3)d，差异均有统计学意义(均P<0.05)。EEN＋PN组和TPN组中ncl－HCC亚组患者的总住院时间分别为(15.1±0.5)d和(16.6±0.3)d，术后总住院时间分别为(8.4±0.2)d和(9.5±0.2)d，差异均有统计学意义(均P<0.05)。EEN＋PN组和TPN组中cl－HCC亚组患者的术后住院时间分别为(8.7±0.2)d和(11.0±0.8)d，差异均有统计学意义(均P<0.05)。EEN＋PN组和TPN组患者的术后住院费用分别为(20 855.0±549.8)元和(23 373.0±715.5)元，差异有统计学意义(P<0.05)；EEN＋PN组和TPN组中cl－HCC亚组患者的术后住院费用分别为(21 012.0±748.5)元和(24 697.0±1 409.0)元，差异有统计学意义(P<0.05)。 结论： EEN＋PN有利于肝部分切除术后HCC患者的肝功能恢复，缩短术后住院时间，减少术后住院费用。.
Keywords: Carcinoma, hepatocellular; Clinical effectiveness; Nutritional support.