《中国恶性肿瘤营养治疗通路专家共识(2018)》解读:外科空肠造瘘

Interpretation of Chinese experts consensus on nutritional therapy access of cancer patients: surgical jejunostomy

恶性肿瘤患者大多处于营养不良状态,尤其是消化道肿瘤患者。由于上消化道肿瘤患者多伴长期进食受限,肿瘤本身的消耗,加上手术创伤性应激反应以及术后短期内需要禁食,患者全身营养情况将进一步恶化;营养状况的恶化将导致患者围术期并发症增加、住院时间延长,甚至死亡风险增加。因此,对这类患者围术期的营养治疗显得尤为重要。外科空肠造瘘是肠内营养的主要途径之一,它使得上消化道肿瘤患者可以术后早期并长期接受肠内营养,补充患者因进食困难或者长期进食量少所引起的营养不足,从而降低患者术后并发症的发生率及缩短住院时间,提高手术疗效,改善患者临床结局。本文主要从外科空肠造瘘的进展、适应证及并发症等方面介绍目前的研究现状。

Most patients with malignant tumors are malnourished,especially patients with digestive tract cancer.Because upper gastrointestinal cancer patients usually have long-term eating restrictions,complicated by the consumption of the tumor itself combined with surgical trauma and the need for fasting within a short period of time after surgery,the systemic nutritional status of patients further deteriorates;this deterioration of nutritional status leads to patients having increased perioperative complications,prolonged hospital stays,and even increased risk of death.Therefore,perioperative nutritional support for such patients is particularly important.Enteral nutrition is the preferred route of nutrition therapy and surgical jejunostomy is one of the main techniques to enable enteral nutrition.Jejunostomy allows patients with upper gastrointestinal cancer to receive early and long-term enteral nutrition after surgery,supplementing nutrition for patients with difficulty eating or postoperative fasting.This nutrition reduces the incidence of postoperative complications and shortens the length of hospital stays,even improving surgical and clinical outcomes.This article mainly describes the current progress,indications and complications of surgical jejunostomy.