目的  探讨术后早期免疫增强型肠内营养治疗对全胃切除老年患者术后营养及免疫功能的影响。方法  选择 我院普外科2015 年 1 月至2016 年 6 月期间接受全胃切除术的68 例进展期老年胃癌患者（＞70 岁）作为研究对象，手 术后随机分为EN+PN 和 PN 组。PN 组患者在半流饮食后停用PN 液。EN+PN 组患者在手术后第1 天经鼻饲管行生理 盐水250ml，第2 天经鼻肠管行肠内免疫营养制剂400ml（瑞能，华瑞制药有限公司，200ml / 瓶），术后第4 天增加至 800~1200ml/d，并停用PN 液。观察术后肛门排气恢复时间、术后并发症发生率、住院时间等，术前1 天、术后第1 天和 第 7 天检测相关的营养和免疫血清指标，观察术后恢复情况，并比较和分析。结果  两组患者术后第 1 天 TP、PA、ALB、 IgG、IgM 水平以及CD4+、CD8+、CD4+/CD8+ 较术前1 天有显著下降（P ＜ 0.05）。术后第7 天 EN+PN 组血清TP、 ALB、PA、IgG、IgM 以及CD4+、CD8+、CD4+/CD8+ 与 PN 组比有显著性差异（P ＜ 0.05）。术后EN+PN 组和PN 组术后 并发症无显著性差异（P ＞ 0.05）。结论  老年胃癌患者行全胃切除术后早期应用免疫增强型肠内营养，可改善营养及免疫 功能，是高龄患者术后营养治疗的选择之一。

Objective To investigate the effects of enteral immunonutrition on recovery, nutritional status, immune function in elderly gastric cancer patients after total gastrectomy. Methods 68 cases of elderly gastric cancer patients postgastrectomy were randomly divided into total PN group, EN+PN group. PN group stopped PN after taking semifluid diet. EN+PN group were tube feeding 250ml saline at the first day, 400ml PN at the second day and stopped PN after increasing to 800~1200ml at the 4th day. The recovery, serum marker on nutritional status and immune function were evaluated and compared before operation and on the 1st, 7th day after operation. Results The levels of serum total protein, albumin, prealbumin were significantly decreased in 2 groups on the 1st day after operation (P<0.05), and they were significantly increasedin EN+PN group on the 7th days after operation (P<0.05). The levels of serum IgG, IgM, the helper cells (CD8+, CD4+) and ratio of CD4+, CD8+, (CD4+/CD8+) were significantly decreased in 2 groups on the 1st day (P<0.05) after operation, and IgG, IgM, CD8+, CD4+and CD4+/CD8+ were significantly increased in EN+PN group (P<0.05) on the 7th day after operation. There were no significant difference in postoperative complication between 2 groups (P>0.05). Conclusions Postoperative early usage of enteral immunonutrition can improve the nutritional status and enhance immunity in elderly gastric cancer patients.