结直肠癌患者的营养治疗专家共识

Expert consensus on nutritional treatment for patients with colorectal cancer

结直肠癌是常见肿瘤之一,结直肠癌患者经常出现营养不良和体重丢失,受摄入减少、肠梗阻和吸收不良的影响,营养不良在结直肠癌患者中比在非胃肠道肿瘤中更常见。结直肠癌患者应通过营养风险筛查2002(NRS 2002)与患者主观整体评估(PG-SGA)进行营养评估。欧洲肠外肠内营养学会(ESPEN)强烈推荐对于所有接受根治性或姑息性手术的肿瘤患者采取加速康复外科(ERAS)方案。ERAS可降低结直肠手术后的并发症发生率、促进康复和缩短住院时间。在ERAS方案中,ESPEN推荐每例患者都应进行营养风险筛查,如果存在营养风险,则给予额外的营养治疗;严重营养不良的患者,术前应进行10~14 d的营养干预,甚至以延迟手术为代价。不同手术方式的选择会对结直肠癌患者的术后并发症发生率、病死率与3年长期存活率等方面产生不同的影响。临床医师应关注患者出院后的营养状态,合理进行营养干预,有计划地对出院时存在营养风险的患者进行随诊。

Colorectal cancer is one of the most common tumors and patients with colorectal cancer often suffer from malnutrition and weight loss.Affected by reduced intake intestinal obstruction and malabsorption malnutrition is more common in colorectal cancer patients than in non-gastrointestinal tumor patients.Patients with colorectal cancer should undergo nutritional risk screening 2002 NRS 2002 and patient-generated subjective globe assessment PG-SGA.The European Society for Parenteral and Enteral Nutrition ESPEN strongly recommends enhanced recovery after surgery ERAS for all tumor patients undergoing radical or palliative surgery.ERAS can reduce the incidence of complications after colorectal surgery promote rehabilitation and shorten hospital stay.In the ERAS protocol ESPEN recommends that every patient should be screened for nutritional risk and if there is nutritional risk additional nutritional support should be given for patients with severe malnutrition nutritional intervention should be carried out for at least 10-14 days before operation even at the cost of delaying operation.Different surgical methods will have different effects on the incidence of postoperative complications mortality and 3-year long-term survival rate of colorectal cancer patients.Clinicians should pay attention to the nutritional status of patients after discharge reasonably carry out nutritional intervention and follow the patients with nutritional risk at discharge in a planned way.