【摘要】  目的 探讨中西医结合肠内营养（EN）对围手术期食管癌患者的影响。方法 将98例食管癌患者随机分为2组，对照组49例给予瑞素营养液治疗；治疗组给予中西医结合治疗：瑞素加中药汤剂扶正解毒冲剂，观察2组患者对T细胞亚群的影响、术后一般状况、术后消化道反应、排便时间、住院费用及住院时间等。结果 治疗组术后1周、2周CD4、CD8及CD4/CD8逐渐恢复正常，尤其是术后2周CD3、CD4/CD8与对照组2周相比差异有统计学意义(P＜0.05)。治疗组一般状况以及术后消化道症状明显好于对照组，而且住院费用明显降低（P＜0.05）。结论 中西医结合EN围手术期的应用可以明显改善食管癌患者的免疫功能和营养状况，且简便、经济，无严重并发症，是临床围手术期简便、安全、有效的营养补给方法。

【关键词】  食管癌；肠内营养；围手术期；中西医结合疗法
   
　　【Abstract】 Objective  To study the effect of combination of Fuzhengjiedu decoction and enteral nutrition in patients with esophageal carcinoma preoperative course. Methods  98 preoperative patients were randomly divided into two groups. 49 patients in control group were treated with enteral nutrition emulsion；the other 49 patients in treatment group were treated by combination of Fuzhengjiedu decoction and enteral nutrition emulsion. To evaluate the effect, T cell subset, the ordinary state, alimentary canal reaction of postoperation, the time of draining defecate , hospitalization expenses  and time for both groups were observed. Results  There were remarkable differences between two groups on CD3, CD4 and CD4/CD8 ratio at the first week of postoperation, especially at the second week (P<0.01). There are some obviously improvement in ordinar无忧论文 【http://www.uklunwen.com】y state，symptoms of alimentary canal reaction of postoperation. The hospitalization expense in treatment group is lower than that in control group(P<0.05). Conclusion  The  Enteral nutrition can significantly improve the nutritional status and immunocompetence, and reduce the occurrence of serious postoperation complication. So it is safe, effective and economical after esophageal carcinoma surgery.
   
　　【Key words】 Esophageal carcinoma; Enteral nutrition; Preoperative course; Combination of Traditional Chinese medicine and Western medicine
 
    食管癌患者由于术前不同程度的进食受限、肿瘤消耗、围手术期禁食以及手术创伤应激代谢增高，术后胃肠道解剖改变及功能障碍等原因，使原有的营养不良及免疫功能低下进一步加重，导致不同程度的蛋白质—能量营养不足。因此，积极改善食管癌患者的营养状况，对减少术后并发症及肿瘤的预后改善有重要意义。

    我院于2004-08—2006-10对98例食管癌患者围手术期实施中西医结合肠内营养（enteral nutrition，EN），并与西医单纯EN对照，就食管癌围手术期中西医结合EN安全性、可行性和临床效果进行观察。

　　1  资料与方法

　　1.1  一般资料

　　我院胸外科收治食管癌患者98例，术前患者心、肺、肝、肾功能均未见异常，无内分泌及代谢性疾病。随机分为2组。治瑞素加中药汤剂组（治疗组）49例，男30例，女19例；年龄38～72岁，平均年龄58.58岁；其中鳞状细胞癌28例，腺癌21例，临床分期：Ⅰ期2例，Ⅱ期30例，Ⅲ期15例，Ⅳ期2例；食管-胃主动脉弓下吻合31例，弓上吻合15例，颈部吻合3例。单纯瑞素组（对照组）49例，男31例，女18例；年龄36～71岁，平均年龄58.6岁；其中鳞状细胞癌30例，腺癌19例，临床分期：Ⅰ期2例，Ⅱ期29例，Ⅲ期17例，Ⅳ期1例；食管-胃主动脉弓下吻合28例，弓上吻合16例，颈部吻合5例。2组在性别、年龄、细胞类型、临床分期等方面差异无统计学意义（P＞0.05），具有可比性。

　　1.2  材料与方法

　　1.2.1  材料与药物 <