肝门部胆管癌多学科营养评估在围术期管理中的价值

The value of multidisciplinary nutritional assessment in perioperative management of hilar cholangiocarcinoma

目的探讨基于多学科团队(multidisciplinary team,MDT)的营养评估在肝门部胆管癌围术期管理中的作用.方法本团队自2013年制定了多学科营养评估流程和营养支持策略,建立了肝门部胆管癌围术期营养管理的临床病例队列,至2019年共有50例病人纳入本研究队列.其中,28例接受多学科营养评估并完成全程营养治疗(全程营养组),22例虽然接受了营养评估,但因多种原因未完成营养治疗(对照组).比较两组病例术后恢复情况和各项检测指标变化.结果①与对照组比较,全程营养组术前减黄时间显著缩短,差异有统计学意义(P<0.05);与对照组比较,全程营养组术后住院时间缩短近一周,术后严重并发症的发生率下降,但没有统计学意义(P>0.05).②与对照组比较,全程营养组术后1、3、7日的血清胆红素有所下降,差异有统计学意义(P<0.05);与对照组比较,全程营养组术后3日的血清C反应蛋有所降低,差异有显著意义(P<0.05).与对照组比较,全程营养组术后血清谷丙转氨酶、谷草转氨酶、血清白蛋白、前白蛋白等检测指标的差异均没有统计学意义(P>0.05).结论由肝胆胰外科医师,营养专业的临床药师,以及营养专科护士共同参与的多学科营养评估和支持模式有利于改善肝门部胆管癌围术期的肝功能,缩短术前减黄时间,促进术后康复.

Objective We aimed to explore the role of nutritional assessment based on multidisciplinary team(MDT)in the perioperative management of hilar cholangiocarcinoma.Patients and methods Since 2013,our team has developed the multidisciplinary nutritional assessment process and nutritional support strategy.The clinical cohort for perioperative nutritional management of hilar cholangiocarcinoma cases was established.Until 2019,a total of 50 patients were recruited into the present research.Among them,28 patients underwent multidisciplinary nutritional assessment and received nutritional support therapy throughout(considered as fullcourse nutritional support group).Other 22 patients receiving nutritional assessment did not finish the full-course nutritional treatment due to various reasons(considered as the reference group).Postoperative recovery conditions and changes of several indicators were compared between the two groups.Results(1)The preoperative drainage time in full-course nutritional support group was much lower than the reference group,the difference was statistically significant(P<0.05).The postoperative duration of hospital stay in fullcourse nutritional support group was nearly one week shorter than the reference group,the difference was not statistically significant(P>0.05).The incidence of serious postoperative complications in full-course nutritional support group was lower than the reference group,the difference was not statistically significant(P>0.05).(2)The level of serum TBil at the 1st,3rd,7th day in full-course nutritional support group was lower than the reference group,the difference was statistically significant(P<0.05).The level of C-re-active protein in full-course nutritional support group was lower than the reference group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the level of postoperative serum ALT,AST,albumin and prealbumin between full-course nutritional support group and reference group(P>0.05).Conclusion The multidisciplinary nutritional assessment and support pattern participated by hepatobiliary and pancreatic surgeons,professional clinical pharmacists and specialist nurses major in nutrition is beneficial to the improvement of liver function of patients with hilar cholangiocarcinoma during the perioperative period.It could also shorten the preoperative drainage time and facilitate rehabilitation after surgery.