Perioperative nutritional support in refractory constipation patients complicated with megacolon / 中华普通外科杂志

ABSTRACT

Objective Refractory constipation,when complicated with megacolon,is difficult to manage.This study aimed to compare the clinical outcomes of different preoperative nutritional therapies on refractory constipation patients complicated with megacolon.Methods Patients of refractory mixed constipation complicated with megacolon receiving surgical interventions between 2006 Jun and 2011 Jun were enrolled.Perioperafive nutrition support was evaluated in terms of postoperative recovery.Results 78 constipation patients received therapies of NPM,gastrointestinal decompression and total parenteral nutrition during the first 7-14 days.34 patients retained intestine patency and after 2 weeks of enteral nutrition therapy,they (enteral nutrition group) successfully received selective surgery.The other 44 patients (non-enteral nutrition group) received emergency surgery after correcting homeostasis.The surgical procedures included Jinling procedure (n =45),Jinling procedure plus ileostomy (n =6),total colectomy plus ileum-rectum side-to-side anastomosis (n =18) and total colectomy plus ileostomy (n =9).EN group patients had a significant low rate of pneumonia (0％ vs 11.4％),anastomotic leakage (0％ vs 11.4％),anastomotic bleeding (2.9％ vs 18.2％) and ostomy (0％ vs 34.1％),compared with N-EN group.At one month follow up,the nutrition status was significantly better in EN group than that in N-EN group.Condusions Refractory constipation complicated with megacolon required surgical intervention.Recovering the intestinal patency and receiving enteral nutritional support therapy preoperatively benefits patient's recovery.