胆囊切除术后早期口服含膳食纤维肠内营养制剂对胆囊结石患者术后肠功能恢复和血清炎症因子短期影响研究

doi:10.3969/j.issn.1672-5069.2026.05.032

摘要/Abstract

摘要： 目的探讨胆囊切除术后早期口服含膳食纤维肠内营养制剂对患者术后肠功能恢复和血清炎症因子的短期影响。方法 2023年5月～2025年4月我院诊治的胆囊结石患者120例,均接受腹腔镜胆囊切除术(LC)治疗。将患者分为两组,分别在术后6 h,给予含膳食纤维肠内营养(n=61)或给予常规肠外营养(n=59)治疗3天。采用ELISA法检测白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、胃泌素(GAS)、胃动素(MTL)和血管活性肠肽(VIP)水平。结果肠内营养组肠鸣音恢复时间、肛门排气时间、排便时间和住院日分别为(9.3±1.7)h、(28.4±3.5)h、(33.4±3.7)h和(5.8±1.2)d,均显著短于肠外营养组【分别为(13.7±2.3)h、(37.8±4.3)h、(41.3±4.7)h和(7.6±1.5)d,P＜0.01】,而住院医疗花费为(2.3±0.4)万元,显著少于肠外营养组【(2.9±0.5)万元,P＜0.01】;在术后72 h,肠内营养组血清IL-6、TNF-α和CRP水平分别为(15.8±3.3)ng/L、(18.5±3.8)ng/L和(28.5±5.7)mg/L,均显著低于肠外营养组【分别为(21.3±4.2)ng/L、(24.7±4.4)ng/L和(36.8±6.9)mg/L,P＜0.01】;肠内营养组血清GAS和MTL水平分别为(105.7±15.8)ng/L和(285.7±42.4)ng/L,均显著高于肠外营养组【分别为(92.3±14.6)ng/L和(245.8±40.1)ng/L,P＜0.01】,而血清VIP水平为(42.3±9.2)ng/L,显著低于肠外营养组【(48.7±10.2)ng/L,P<0.01】。结论胆囊切除术后早期应用肠内营养(含膳食纤维制剂)可有效促进胃肠功能恢复、减轻炎症反应,其效果明显优于肠外营养。

关键词: 胆囊切除术, 早期, 膳食纤维肠内营养制剂, 术后排气时间, 炎症因子, 胃泌素

Abstract: Objective The aim of this study was to investigate the short-term effects of early oral administration of dietary fiber containing enteral nutrition preparations on postoperative gastrointestinal functions and serum inflammatory factors in patients with gallbladder stones after laparoscopic cholecystectomy (LC). Methods 120 patients with gallbladder stones were encountered in our hospital between May 2023 and April 2025, and all underwent LC operation. After surgery, patients were randomly assigned to receive enteral nutrition containing dietary fiber in 61 cases, or receive conventional parenteral nutrition in another 59 cases for three days. Serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), gastrin (GAS), motilin (MTL) and vasoactive intestinal peptide (VIP) levels were detected by ELISA. Results Bowel sound recovery, anal exhaust, defecation time and hospital stay in the enteral nutrition group were(9.3±1.7)h, (28.4±3.5)h, (33.4±3.7)h and (5.8±1.2)d,all significantly shorter than [(13.7±2.3)h, (37.8±4.3)h, (41.3±4.7)h and (7.6±1.5)d,respectively, P＜0.01],while medical cost was (20.3±4.0) thousand yuan, significantly less than [(29.0±5.0)thousand yuan, P＜0.01] in the parenteral nutrition group;by 72 h,serum IL-6, TNF-α and CRP levels were (15.8±3.3)ng/L, (18.5±3.8)ng/L and (28.5±5.7)mg/L,all much lower than [(21.3±4.2)ng/L, (24.7±4.4)ng/L and (36.8±6.9)mg/L,respectively, P＜0.01] in the parenteral nutrition group;serum GAS and MTL levels were (105.7±15.8)ng/L and (285.7±42.4)ng/L,both much higher than [(92.3±14.6)ng/L and (245.8±40.1)ng/L,respectively, P＜0.01],while serum VIP level was (42.3±9.2)ng/L,much lower than [(48.7±10.2)ng/L,P<0.01] in the parenteral nutrition group. Conclusion Early oral administration of enteral nutrition, including dietary fiber preparations after LC could effectively promote gastrointestinal function recovery and reduce inflammatory reactions.

Key words: Gallbladder stones, Laparoscopic cholecystectomy, Dietary fiber enteral nutrition preparation, Gastrointestinal functions, Cytokines, Gastrin

宋俊鑫, 张珍, 郑幼伟, 李文生. 胆囊切除术后早期口服含膳食纤维肠内营养制剂对胆囊结石患者术后肠功能恢复和血清炎症因子短期影响研究[J]. 实用肝脏病杂志, 2026, 29(5): 765-768.

Song Junxin, Zhang Zhen, Zheng Youwei, et al. Short-term effects of early oral administration of dietary fiber containing enteral nutrition preparations on postoperative gastrointestinal functions and serum inflammatory factors in patients with gallbladder stones after cholecystectomy[J]. Journal of Practical Hepatology, 2026, 29(5): 765-768.

参考文献

[1] 王卿,涂小磊,侯佳佳.不同气腹压力腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者对呼吸和肝肾功能的影响比较研究.实用肝脏病杂志, 2025,28(06):934-937.
[2] Chen ZY, Han XD, Liu M, et al. Effects of rapid recovery nursing after surgery in patients with acute calculous cholecystitis after laparoscopic cholecystectomy. World J Gastrointest Surg, 2025,17(9):106543.
[3] Tanes C, Bittinger K, Gao Y, et al. Role of dietary fiber in the recovery of the human gut microbiome and its metabolome. Cell Host Microbe, 2021,29(3):394-407,e5.
[4] 齐欣,夏宇飞,刘思睿,等.膳食纤维在超短肠综合征肠康复治疗中的作用研究.中华临床营养杂志, 2024, 32(4):217-225.
[5] Fu Y, Moscoso DI, Porter J, et al. Relationship between dietary fiber intake and short-chain fatty acid-producing bacteria during critical illness: A prospective cohort study. JPEN J Parenter Enteral Nutr, 2020,44(3):463-471.
[6] 中华医学会外科学分会胆道外科学组,中国医师协会外科医师分会胆道外科医师委员会. 胆囊良性疾病外科治疗的专家共识(2021年版).中华外科杂志,2022,60(1):4-9.
[7] Ridtitid W, Karuehardsuwan J, Faknak N, et al. Endoscopic gallbladder stenting to prevent recurrent cholecystitis in deferred cholecystectomy: a randomized trial. Gastroenterology, 2024,166(6):1145-1155.
[8] Curry J, Chervu N, Cho NY, et al. Percutaneous cholecystostomy tube placement as a bridge to cholecystectomy for grade iii acute cholecystitis: a national analysis. Surg Open Sci, 2024,18:6-10.
[9] Pérez-Calatayud ÁA, Carillo-Esper R. Role of gastric ultrasound to guide enteral nutrition in the critically ill. Curr Opin Clin Nutr Metab Care, 2023,26(2):114-119.
[10] Fell DM, Bitetto EA, Skillman HE. Timing of enteral nutrition and parenteral nutrition in the PICU. Nutr Clin Pract, 2023,38 Suppl 2:S174-S212.
[11] Arunachala Murthy T, Chapple LS, Lange K, et al. Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (icu) patients: risk factors, natural history, and clinical implications. a post-hoc analysis of the augmented versus routine approach to giving energy trial (target). Am J Clin Nutr, 2022,116(2):589-598.
[12] Robinson DT, Calkins KL, Chen Y, et al. Guidelines for parenteral nutrition in preterm infants: the american society for parenteral and enteral Nutrition. JPEN J Parenter Enteral Nutr, 2023,47(7):830-858.
[13] Baik SM, Kim M, Lee JG. Comparison of early enteral nutrition versus early parenteral nutrition in critically ill patients: a systematic review and meta-analysis. Nutrients, 2024,17(1):10.
[14] 闫太安,王华伟,陈秀珍.含膳食纤维的肠内营养联合益生菌对老年重症脓毒症患者肠黏膜屏障的影响观察.中华保健医学杂志, 2023, 25(5):570-572.
[15] Kashiwagi S, Kanda N, Yoshida M, et al. Effects of early enteral nutrition on persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients: A claims database study using a propensity score analysis. Clin Nutr, 2024,43(8):1872-1879.
[16] Hajipour A, Afsharfar M, Jonoush M, et al. The effects of dietary fiber on common complications in critically ill patients; with a special focus on viral infections; a systematic reveiw. Immun Inflamm Dis, 2022,10(5):e613.
[17] 赵辉,应华良,王佳婷,等.不同肠内营养制剂对脓毒症患者的临床效果观察.中国中西医结合急救杂志, 2022, 29(4):430-434.
[18] Xiao F, Gao X, Hu H, et al. Exclusive enteral nutrition exerts anti-inflammatory effects through modulating microbiota, bile acid metabolism, and immune activities. Nutrients, 2022,14(21):4463.
[19] Huwiler VV, Scalise M, SchÏnenberger KA, et al. The role of dietary fibre in enteral nutrition in sepsis prevention and therapy: a narrative review. Nutrients, 2023,15(11):2489.
[20] Makki K, Brolin H, Petersen N, et al. 6α-hydroxylated bile acids mediate TGR5 signalling to improve glucose metabolism upon dietary fiber supplementation in mice. Gut, 2023,72(2):314-324.