腹腔镜辅助小切口空肠造口术在晚期恶性肿瘤患者肠内营养治疗中的应用

Application of laparoscopic-assisted jejunostomy in enteral nutrition therapy for patients with advanced cancer

目的探讨腹腔镜辅助小切口细针穿刺导管空肠造口术(FKJ)在晚期恶性肿瘤患者肠内营养治疗中的可行性及安全性。方法选取2020年4月至2022年2月浙江大学附属金华医院收治的6例晚期恶性肿瘤进展导致完全性上消化道梗阻患者,充分知情后全麻下行腹腔镜辅助小切口FKJ,其中4例行术中导管浆肌层潜行加包埋。结果6例患者手术均顺利完成,无术中、术后手术相关并发症。术后通过导管行营养支持治疗。6例患者均接受相应的化疗,耐受性好,出院后继续居家营养支持治疗。随访4~6个月,2例未行浆肌层潜行加包埋患者术后2个月出现肠液外渗,另4例患者未出现肠液外渗。术后生存期2.5~5.3个月,中位生存期3.3个月。结论腹腔镜辅助小切口FKJ用于晚期恶性肿瘤患者的肠内营养治疗安全可行,可为患者后续抗肿瘤治疗提供保障,术中浆肌层潜行加包埋可有效预防术后肠液外渗,值得临床推广应用。

Objective To investigate the efficacy and safety of laparoscopic-assisted fine-needle catheter jejunostomy(FKJ)in enteral nutrition therapy for patients with advanced cancer.Methods Six patients with complete upper digestive tract obstruction caused by advanced cancer were treated in Affiliated Jinhua Hospital,Zhejiang University School of Medicine from April 2020 to February 2022.A laparoscopic-assisted FKJ device was implanted under general anesthesia in 6 patients,among whom 4 patients received catheters embedded in seromuscular layer during operation.Results The operation of 6 patients was successful without intraoperative or postoperative complications.Enteral nutritional therapy was carried out through the FKJ device after the operation.After corresponding chemotherapy,patients were successfully discharged from the hospital and continued to receive nutritional support at home.Two patients who did not receive the seromuscular layer embedding had intestinal fluid leakage 2 months after operation,which did not occur in 4 patients with seromuscular layer embedding.The postoperative survival time was 2.5-5.3 months,with a median survival time 3.3 months.Conclusion Laparoscopic assisted fine-needle catheter jejunostomy is safe and feasible in enteral nutrition therapy for patients with advanced cancer.Intraoperative seromuscular embedding can effectively prevent postoperative intestinal fluid leakage,which is worthy of clinical application.