The impact of enteral nutrition on the development of portal vein thrombosis after esophagogastric devascularization and splenectomy / 中华肝胆外科杂志

ABSTRACT

Objective To investigate the change of the hemodynamics of the portal vein and the impact on portal vein thrombosis after esophagogastric devascularization and splenectomy (EDS) with early enteral nutrition.The impact of early enteral nutrition on portal vein thrombosis was studied.Methods 93 patients who underwent EDS in our hospital from January 2017 to January 2015 were randomly assigned to the control group and the study group.In the study group,a nasogastric tube was placed 20 cm into the duodenum-jejunum region.Enteral nutrition was administered via the nasogastric tube 6 hours after the operation.The patients in control group were treated with total parenteral nutriction after the operation.The changes in the diameter of the portal vein,the blood flow velocity and the blood flow of the portal vein were monitored by color Doppler before and after the operation.The relationships of these measurements with formation of portal vein thrombosis were compared with the control group.Results In the enteral nutrition study group,the maximum velocity of the portal vein blood flow decreased from (25.9s-5.6) cm/s before operation to (16.8±5.0) cm/s after operation,and the difference was statistically significant (P＜0.01).The average velocity of portal vein blood flow decreased from (20.6±4.6) cm/s to (14.8±4.2) cm/s after operation,and the difference was also statistically significant (P＜0.01).With the increase in enteral nutrition speed and volume,the average blood flow velocity of the portal vein and the blood flow increased significantly,especially after the third day with the use of Kang Quan Gan,and the difference was statistically significant compared with the control group (P＜0.01).The diameter of the trunk of the portal vein in the study group was wider than that in the control group,and the difference was statistically significant (P＜0.01).The incidences of portal vein thrombosis in two groups were compared.The results showed that the incidence of portal vein thrombosis in the study group (2/48,4.0％) was significantly lower than that in the control group (9/45,20.0％),and the difference was statistically significant (P＜0.05).Conclusion Early enteral nutrition aftcr EDS not only provided enough nutrition,but also reduced portal vein thrombosis rate and promoted liver functional recovery by promoting portal venous blood flow.