食管癌放疗患者的营养治疗

Nutrition therapy for esophageal cancer patients treated with radiotherapy

食管癌是我国发病率第五位和死亡率第四位的恶性肿瘤。放射治疗是食管癌最重要的综合治疗手段之一。食管癌患者营养不良发病率高,居所有恶性肿瘤第一位。放疗患者由于肿瘤本身导致的吞咽梗阻和放疗相关并发症的影响,营养不良的发生率更高。营养不良降低食管癌患者的放疗敏感性和精确性,增加放疗不良反应,影响放疗的顺利完成,最终影响患者生存和生活质量。积极的营养治疗对食管癌放疗患者的治疗和预后具有重要意义,受到越来越多肿瘤学者的重视。特别是对于伴有营养不良的食管癌患者,放疗期间的营养治疗应该成为综合治疗中不可缺少的组成部分。目前,食管癌放疗患者营养治疗具体的实施方法没有统一的标准和规范。食管癌放疗患者的营养治疗包括全肠内营养、全肠外营养、部分肠外联合部分肠内营养。本文对食管癌的营养治疗目标、适应证、治疗时机、治疗途径、营养配方、营养治疗相关并发症的预防和治疗以及家庭营养治疗等方面进行阐述,希望能对放射肿瘤学者开展食管癌营养治疗提供一定的参考和建议。

Esophageal cancer was the ffth most common incident cancer and the fourth most lethal cancer in China. Radiation therapy was one of the most important treatment for esophageal cancer. The incidence of malnutrition in esophageal cancer is the highest in all malignant tumors. Because of swallowing obstruction due to primary tumor and radiation therapy related complications, the incidence of malnutrition in esophageal cancer patients treated with radiaotherapy was higher. Malnutrition might reduce the radiation sensitivity and precision, increase adverse reactions, affect the completion of the radiation, reduce the survival and quality of life. Nutritional therapy played an important role for the treatment and prognosis of esophageal cancer treated with radiotherapy. More and more oncologists payed attention to the nutritional therapy. For the esophageal patients with the risk of malnutrition, nutritional therapy was an indispensable part of combined modality therapy during radiotherapy. There was no criteria or specifcation about the method of nutritional therapy for esophageal cancer treated with radiotherapy. The nutritional therapy contained enteral nutrition, parenteral nutrition and partal enteral combined parenteral nutrition. This article mainly expounded the purpose, indications, optimal time, therapeutic approach, nutrients, nutrition related complication prevention and treatment and home nutritional therapy, which would give some reference and advice to the radiation oncologists when conducting nutritional therapy.