摘要
目的探讨胸导管结扎对食管癌患者术后脂类代谢的影响。方法将74例食管癌手术患者分成胸导管结扎组（39例）和胸导管不结扎组（35例）。两组均在术中置入鼻十二指肠管，从术后第1天开始肠内营养直到术后第8天。所有病例均从术后第6天经口进食流质饮食。入院第2天、手术后第9天、术后1个月、术后3个月采晨空腹静脉血，检测血浆胆固醇、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL-C）浓度，对两组数据进行分析。结果两组间患者血浆胆固醇、TG、HDL—C浓度在术前、术后各时间点差异均无统计学意义。结扎组血浆LDL—C浓度在术后第9天与术前及未结扎组比较，差异有统计学意义（P〈0．05），术后1个月降为最低点。结论胸导管结扎阻断乳糜微粒入血，LDL—C生成减少，对脂类的吸收、代谢有不良影响。胸导管结扎后，其侧支循环的建立缓慢，对食管癌手术患者早期的营养有负面影响。
Objective To explore influence of thoracic duct ligation on lipid metabolism after esophagectomy. Methods Seventy-four patients with esophageal cancer received esophagectomy were divided into two groups by their thoracic duct ligation, 39 in ligation group and 35 in non-ligation group. All the patients were fed with nutrients through nasal-duodenal tube placed during operation from the 1st day to the 8th day after surgery, and started taking liquid diet on the 6th day. Blood specimens were collected from the patients on the 1st day after admission, the 9th day, one month and three months after surgery, respectively for biochemical analysis, including determinations of total cholesterol （ TC）, triglyceride （TG）, high-density lipoprotein-cholesterol （ HDL-C ） and low-density lipoprotein-cholesterol （ LDL-C ） . Data between the two groups were compared with statistical analysis. Results No significant difference in plasma levels of TC, TG and HDL-C was found between the two groups at varied time points. Plasma level of LDL-C in the ligation group significantly decreased on the 9th day after surgery, as compared with that in the nonligation group （ P 〈 0. 05 ）, and went down to the lowest level one month after surgery. Conclusions Chylomicron was blocked to enter blood stream and production of LDL-C decreased by thoracic duct ligation, which affect lipid absorption and metabolism leading to poor early nutrition in patients with esophageal surgery due to slower establishment of collateral circulation.
出处
《中华全科医师杂志》
2009年第12期880-883,共4页
Chinese Journal of General Practitioners
关键词
胸导管
食管肿瘤
脂代谢障碍
侧支循环
Thoracic duct
Esophageal neoplasms
Lipid metabolism disorders
Lateral circulation
