回肠造口联合营养支持治疗慢性放射性肠损伤  

Treatment of Chronic Radiation Intestinal Injury by Ileostomy Combined with Perioperative Nutrition Support Therapy

作　　者：李顾楠 程康文 赵振国[2] 王剑[2] 朱维铭[2] 黎介寿[2] LI Gu-nan;CHENG Kang-wen;ZHAO Zhen-guo;WANG Jian;ZHU Wei-ming;LI Jie-shou(Department of Gastrointestinal surgery, Changzhou Tumor Hosipital Affiliated to Soochow University, Changzhou 213032, Jiangsu, China;Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, Jiangsu, China)

机构地区：[1]苏州大学附属常州肿瘤医院胃肠外科,江苏常州213001 [2]南京军区南京总医院普通外科,江苏南京210002

出　　处：《肠外与肠内营养》2018年第3期147-150,共4页Parenteral & Enteral Nutrition

基　　金：江苏省自然科学基金(BK2011415);国家自然科学基金(81200327)

摘　　要：目的:总结回肠造口联合营养支持在治疗慢性放射性肠损伤中的应用。方法:回顾分析2012年1月至2016年12月在南京军区南京总医院普通外科接受一期回肠造口术联合围手术期营养支持的慢性放射性肠损伤病人的病历资料,观察短期并发症、围手术期营养过程,随访其远期预后。结果:46例慢性放射性肠损伤病人纳入研究,术后并发症发生率为36.96%,所有病人出院时均恢复全肠内营养支持,时间为(18±15)d,无病人死亡。随访率78.26%,随访时间(25±17)个月。随访期间肿瘤复发7例(19.44%),死亡6例(16.67%)。除死亡病人外其余30例病人(83.33%)均维持全肠内喂养,其中27例病人(75%)恢复正常饮食。21例(58.33%)后于我院行造口还纳手术,术后恢复良好。结论:对选择的放射性肠损伤病人,回肠造口联合围手术期营养支持可以有效恢复肠道通畅性和全肠内营养,可以有效降低病人死亡率。Objective： To review the application of ileostomy combined with perioperative nutrition support therapy in the treatment of chronic radiation intestinal injury.Methods： The clinical data of patients with chronic radiation intestinal injury who received ileostomy combined with perioperative nutrition support therapy in the department of general surgery, Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2016 were retrospectively analyzed. The short-term complications and perioperative nutrition process were recorded, and the longterm prognoses were followed up.Results： Forty-six patients were included in the study. The overall postoperative complication rate was 36.96%. All the patients restored total enteral nutrition at the time of discharge（18±15） days. There was no post-operative mortality. Thirty-six patients were followed up（follow-up rate of 78.26%）, and the followup time was（25 ± 17） months. Tumor recurrence was occurred in 7 patients（19.44%） during follow-up and 6 deaths（16.67%）. All of the 30（83.33%） survived patients maintained total enteral feeding, 27 of whom（75%） returned to normal diet. Twenty-one patients（58.33%） underwent a second staging ostomy surgery in our hospital and recovered well. Conclusion： For selected patients with chronic radiation intestinal injury, ileostomy combined with perioperative nutrition support therapy could effectively restore intestinal patency and total enteral nutrition, and reduce the mortality.

关 键 词：慢性放射性肠损伤 回肠造口术 营养支持 

分 类 号：R818.74[医药卫生—放射医学]