TPN在消化道恶性肿瘤治疗中的应用(附73例报告)

The application of TPN in treating malig- nant tumor in digestive tract(enclosing73 case reports)

完全胃肠外营养 ( TPN)既能改善恶性肿瘤所致机体的营养不良 ,又能刺激肿瘤生长 ,如何扬长避短 ,是人们关注的焦点。 1994年 7月至 1995年 12月期间 ,我们对 73例消化道恶性肿瘤病人在抗肿瘤治疗的同时 ,给予 TPN支持 ,效果良好 ,总结如下 :1围手术期及化疗病人是 TPN的适应证 ,可减少术后并发症 ,增强化疗效果 ;2癌症晚期不能手术切除及非化疗病人 TPN支持无意义 ;3手术和化疗加重病人应激性 ,机体处于高分解代谢状态 ,故应用 TPN应坚持支持代谢原则 ;4补服谷氨酰胺 ( Gln)和硒对肿瘤治疗是有益的 ;5TPN中提高脂肪供能比例 ,减少或增加某些氨基酸对控制肿瘤生长可能有益 。

TPN can not only improve the malnutrition of organism resulted from ma- lignant tumour,but also slimulate the growth of tumour.Therefore,how to make best advantages of TPN is of great concern. From July1 994to December1 995 ,we treat- ed73patietns with malignant tumour in di- gestive tract by applying TPN,and achieved very good curative effects. We sum up our experience as following:1 perioperation and chemotherapy is a good indication oTPN which can reduce post- operation com- plication and enhance effect of chemothera- py;2 Itis contraindication of TPN to termi- nal cancer patients without operation and chemotherapy patients,TPN support is helpless;3 Operation and chemotherapy may aggravate the patients stress and cause a high matabolic rate in organism,so application of TPN should stick to the prin- ciples of metabolic support;4Taking Glu- tamine(GLN) and Se will benefit the treat- ment of tumour;5 It amy be helpful to check the growth of tumour by increasing fat emulsion,decreasing or increasing cer- tain amino acid. The questions mentioned above need futher study.