营养支持联合新辅助化疗在结直肠癌伴不全梗阻病人中的应用  

Application of nutritional support combined with neoadjuvant chemotherapy in colorectal cancer patients with incomplete obstruction

作　　者：朱文强[1] 吴震峰[1] 曹勤洪[1] 陈志伟[1] 朱淼[1] 吴晓宇[1] 陈彻[1] ZHU Wen-qiang WU Zhen-feng CAO Qin-hong CHEN Zhi-wei ZHU Miao WU Xiao-yu CHEN Che(Department of Surgical Oncology, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, Jiangsu , China)

机构地区：[1]南京中医药大学附属江苏省中医院消化肿瘤外科,江苏南京210029

出　　处：《肠外与肠内营养》2016年第5期290-292,296,共4页Parenteral & Enteral Nutrition

摘　　要：目的:观察营养支持联合新辅助化疗对结直肠癌伴不全梗阻病人的术前营养改善和梗阻缓解情况。方法:回顾性分析经保守治疗暂时缓解梗阻的结直肠癌病人87例。分别于入院后第2天、手术前3 d使用营养风险筛查工具(NRS 2002)评估病人的营养风险状况,测定身高、体重、BMI,检查血清清蛋白、前清蛋白、血红蛋白、白细胞以及肿瘤标记物癌胚抗原(CEA)。在保守治疗期间,通过灌肠或口服缓泻药物行肠道准备,然后行肠镜检查。经病理诊断明确后行新辅助化疗,方案为FOLFOX4,所有病人完成2个疗程的静脉化疗。治疗期间,根据病人梗阻症状缓解的情况,逐步调整营养支持方式。结果:在87例病人中,65例(74.71%)病人的梗阻症状得到明显缓解,营养支持方式由全胃肠外营养(TPN)转为全肠内营养(TEN)支持;22例(25.29%)病人的梗阻症状稍有缓解,营养支持方式由TPN转为PN+EN支持。术前病人营养风险明显降低,营养状况明显改善。CEA阳性的病人数虽无明显变化,但阳性的数值较入院时明显降低。结论:营养支持联合新辅助化疗在结直肠癌伴不全梗阻的病人中可改善其营养状况,降低营养风险,缓解梗阻症状,减轻肿瘤负荷,为限期手术创造条件。Objective： To observe the effect of nutritional support combined with neoadjuvant chemotherapy on the improvement of nutritional status and relief of obstruction symptoms in colorectal cancer patients with incomplete obstruction. Methods： 87 cases of colorectal cancer patients with tem- porary relief of obstruction after conservative treatment were enrolled. On the second day after admission and before the surgery, nutritional risk screening tool （NRS 2002 ） was used to assess the nutritional risk. Height, weight and BMI were measured. The serum albumin and prealbumin, hemoglobin, white blood cells and CEA were tested. During the period of conservative treatment enema or oral laxative medi- cine were executed for bowel preparation, and then colonoscopy were performed. Neoadjuvant chemother- apy was implement after the clear pathology. The chemotherapy regimen was FOLOFX4. All patients completed 2 courses of intravenous chemotherapy. During the treatment, according to the relief of the symptoms of patients with obstruction, and the nutritional support mode was adjusted. Results： In 87 patients, 65 patients （74.71% ） with obstructive symptoms were significantly relieved, and the nutritional support mode was converted from total parenteral nutrition （TPN） to total enteral nutrition （TEN）. Nutritional risk was significantly lower in all patients before surgery, and nutritional status was significantly improved. Although there was no significant change in the number of CEA positive patients, the CEA value of the positive patients was significantly decreased. Conclusion ： The application of nutritional support combined with neoadjuvant chemotherapy in colorectal cancer patients with incomplete obstruction can improve nutritional status, reduce nutritional risk, relieve obstruction symptoms, and reduce tumor load.

关 键 词：结直肠癌 不全梗阻 营养风险筛查 营养支持 新辅助化疗 

分 类 号：R735.34[医药卫生—肿瘤] R459.3[医药卫生—临床医学]