International Medical Journal, Vol. 23., Iss. 4, 2017, P. 30−35.
FEATURES OF FEEDING IN SURGICAL PATIENTS WITH SEVERE DYSPHAGIA
V. T. Zaitsev Institute of General and Emergency Surgery, NAMS of Ukraine, Kharkiv
Kharkiv National Medical University, Ukraine
The ultimate goal of the treatment of patients with severe dysphagia is returning the possibility of alimentary nutrition by natural way, which is achieved by reconstructive surgeries, which are possible only after the restoration of the trophological status, or by holding dilatation procedures or coughing (only in compensated patients). To restore the trophological status in hospitals, both parenteral and enteral nutrition is used with the possibility of its realization. The work analyzed the results of surgical treatment of patients with extended postoperative scar strictures of the esophagus, taking into account the type of therapeutic nutrition. All examined patients had a nutritional deficiency. In order to provide the adequate parenteral nutrition and surgical treatment to prevent postoperative complications, and in case of their occurrence −− reduction of their severity at all stages of inpatient treatment, the third generation fat emulsion «Nutriflex Omega» was used. The patients who were able to receive enteral nutrition via probe (including gastrostomy) and natural pathways were used prior to surgical intervention and in the postoperative period «Nutricomp» balanced nutrition. Given the severity of the course of this disease, the general condition of patients with severe malnutrition status due to the ability to provide them with adequate enteral and parenteral support, the following tactics (algorithm) of treatment was proposed. All patients with disorders of the nutritional status are subject to dilatation procedures. When the esophagus passage is restored for a certain period of time, the passage of food in a natural way is created. But in the future, these patients need repeated bouginage or balloon dilation, and then reconstructive−restorative operative treatment −− esophagoplasty, which ensures the passage of food in a natural way. With ineffectiveness of the courses of dilatation procedures and impossibility of their conducting the patients develop exhaustion with severe metabolic disorders, and sometimes even cachexia. Such patients are subject to two−stage surgical treatment: at the first stage gastrostomy is performed for the purpose of establishing enteral nutrition and improvement of the trophological status; on the second stage −− after the restoration of the trophological status, an operative intervention is performed in the volume of the esophagus resection, esophagoplasty and closure of the gastrostomy opening, which also provides restoration of the natural passage of food. For the period of treatment with surgical intervention, such patients developed complications. But in patients receiving both parenteral and enteral nutrition complications arose in 4,2 % of cases, in contrast to the patients with only enteral nutrition, in which this figure was 21,9 %, and patients with only parenteral nutrition, in which complications were observed in 25,0 % of cases. There are differences in the indicators of mortality: in patients who received parenteral and enteral nutrition at the same time, no lethal cases were observed, while in the other two groups it was 7,3 % in the presence of only enteral nutrition and 6,8 % with only parenteral. Taking into account the results of this study on the surgical treatment of patients with severe dysphagia, regardless of tactics and surgical intervention method, it is noted that simultaneous use of enteral and parenteral nutrition at all stages is the basis for obtaining better postoperative results in comparison with the separate application of enteral or parenteral nutrition.
Key words: enteral nutrition, parenteral nutrition, dysphagia, surgical treatment.