肝胰十二指肠器官簇移植围手术期营养支持疗法探讨  

Perioperative nutrition support therapy for combined ＇ en bloc＇ liver/pancreas transplantation

作　　者：鞠卫强[1] 周健[1] 何晓顺[1] 王东平[1] 朱晓峰[1] 巫林伟[1] 邰强[1] 郭志勇[1] 黄洁夫[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华临床营养杂志》2012年第2期74-77,共4页Chinese Journal of Clinical Nutrition

基　　金：广东省科技计划项目（20108031600200）和广东省医学科研基金（A2010149）

摘　　要：目的探讨肝胰十二指肠器官簇移植围手术营养支持疗法的合理方案。方法我中心自2004年5月至2010年9月共实施了10例肝胰十二指肠器官簇移植手术，其中5例为上腹部肿瘤伴腹腔多发转移病灶患者，行肝脏、胰腺及上消化道全切除术后进行器官簇移植，5例为乙型肝炎后肝硬化失代偿期合并2型糖尿病患者，予以单纯肝切除后行器官簇移植。对这10例患者进行围手术期营养支持疗法，术前经口进食辅以口服营养液改善患者营养状况，术后先给予全肠外营养（total parenteral nutrition，TPN），后转为肠外联合肠内营养，逐渐过渡至肠内营养（enteralnutrition，EN）。观察患者术后肠道功能恢复情况、患者营养状况、各项实验室指标及并发症情况。结果10例患者手术顺利，术后肝脏、胰腺及十二指肠功能恢复良好。3例患者出现肠瘘，经TPN营养支持，2例死于感染致多器官功能衰竭，1例痊愈；其余7例患者均顺利由TPN过渡至EN，营养状况良好。5例肿瘤患者最长存活326d，3例死于多器官功能衰竭，2例死于肿瘤复发。5例肝硬化合并糖尿病患者除1例于术后4周死于移植物抗宿主病外，其余4例均存活，最长生存时间已超过24个月。结论合理的围手术期营养支持疗法对肝胰十二指肠器官簇移植成功有一定作用。Objective To investigate a reasonable perioperative nutrition support therapy for combined ＇en bloc＇ liver/pancreas transplants （CLPT）. Method The clinical data of 10 patients, 5 with gastrointestinal malignancy and liver metastasis and the other 5 with end-stage liver cirrhosis complicated with insulin-dependent type 2 diabetes mellitus （ T2DM）, who had undergone CLPT in our center from May 2004 to September 2010 were retrospectively analyzed. All these patients received preioperative nutrition support, including normal food combined with nutrient solution before surgery, and total parenteral nutrition （TPN） to parenteral nutrition （PN） ＋ enteral nutrition （EN） and to EN after surgery. The intestinal absorption, nutritional status, laboratory test results, and complications were recorded. Results All recipients experienced a smooth recovery from the procedure, with normal or almost normal liver, pancreas, and duodenum graft functions. Three patients suffered from intestinal fistula, and all of them received TPN therapy; two patients died of multiple organ failure and one recovered from the complication. The remaining seven patients had smooth transition from TPN to EN. Of the 5 patients with malignancies, three died of multiple organ failure and 2 died of cancer recurrence. Of the 5 patients with liver cirrhosis and T2DM, four patients survived and 1 patient died of graft-verse-host disease. Conclusion Rational perioperative nutrition support is important for the successful recovery after CLPT.

关 键 词：肝胰十二指肠器官簇移植 围手术期 营养支持疗法 

分 类 号：R473.73[医药卫生—护理学]