序贯式营养治疗在儿童胰腺肿瘤术后的应用效果

Eff ect of sequential nutritional support on children with pancreatic tumor after operation

目的探讨儿童胰腺肿瘤术后序贯式营养治疗的效果,为儿童胰腺肿瘤术后规范化营养管理提供依据。方法回顾性收集行胰腺肿瘤切除且有完整随访数据的13例患儿的临床资料,术后均采用序贯式营养治疗,即全肠外营养(total parenteral nutrition,TPN)-肠外营养(parenteral nutrition,PN)+肠内营养(enteral nutrition,EN)-全肠内营养(total enteral nutrition,TEN)-特殊膳食-正常膳食,总结其营养支持效果,并对其中7例胰母细胞瘤患儿的生长发育情况进行随访。结果 13例胰腺肿瘤患儿年龄中位数为6岁(3~14岁)。7例为胰母细胞瘤,6例为胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP),所有患儿均成功手术。4例(30.8%)术后有并发症(1例十二指肠梗阻、2例急性胰腺炎和1例胰腺假性囊肿)。术中放置鼻空肠管的患者(n=9)较经口喂养的患者(n=4)并发症发生率低(11.1%vs 75.0%,P=0.052)。术后所有患者均行序贯式营养治疗,患儿术前1 d与术后1个月身高别体质量(weight-for-height,WHZ)/年龄别体质量指数(body mass indexfor-age,BAZ)和年龄别身高(height-for-age,HAZ)比较,差异均无统计学意义(均P>0.05);但营养不良发生率下降(术前30.8%vs术后15.4%,P=0.045),且术前与术后白蛋白水平和前白蛋白水平比较,术后均升高(均P<0.05)。7例胰母细胞瘤患儿在术后1、3和6个月WHZ/BAZ升高,各时间点之间比较,差异具有统计学意义(P=0.046),而HAZ术后各时间点比较差异无统计学意义(P=0.558)。结论儿童胰腺肿瘤术后行序贯式营养治疗,可有效保障营养吸收的连续性和耐受性,改善术后营养状况,减少并发症;胰母细胞瘤患儿术后半年可呈追赶性生长。

Objective To evaluate the effect of sequential nutrition support in children with pancreatic tumor after operation and to provide the basis for standardized nutrition management.Methods The clinical data of 13 children who underwent pancreatectomy and had complete follow-up data were collected retrospectively.All 13 patients were treated with sequential nutrition therapy,total parenteral nutrition(TPN)-parenteral nutrition(PN)+enteral nutrition(EN)-total enteral nutrition(TEN)-special diet-normal diet.Seven children with pancreatoblastoma were followed up.Results The median age of 13 patients with pancreatic tumor was 6 years,ranging from 3 to 14 years.Seven patients had pancreatoblastoma and 6 patients had solid pseudopapillary tumor of the pancreas(SPTP).Thirteen patients were operated successfully.Four patients(30.8%)had postoperative complications(1 case of duodenal obstruction,2 cases of acute pancreatitis and 1 case of pancreatic pseudocyst).Nasojejunal tubes were placed in 9 patients during the operation,and the incidence of complications of these patients was lower than that of the four oral feeding patients(11.1%vs 75.0%,P=0.052).All patients received sequential nutrition therapy.There was no significant difference in Z score of weight-for-height(WHZ)/body mass index-for-age(BAZ)and height-for-age(HAZ)between one day before operation and one month after operation.However,the incidence of malnutrition decreased(30.8%preoperative vs 15.4%postoperative),and the levels of albumin and prealbumin were increased after operation compared with those before operation(all P<0.05).The WHZ/BAZ of 7 patients with pancreatoblastoma was increased at 1,3 and 6 months after operation,and the difference was statistically significant(P=0.046).There was no significant difference in HAZ at each time point after surgery(P=0.558).Conclusions Sequential nutritional therapy after surgery for pediatric pancreatic tumor can effectively guarantee the continuity and tolerance of nutritional absorption,improve postoperative nutritional status and reduce complications.The children with pancreatoblastoma show catch-up growth half a year after operation.