中国恶性肿瘤营养治疗通路专家共识解读:非外科空肠造口  

Interpretation of Chinese experts consensus on nutritional therapy access of cancer patients: non-surgical jejunostomy

作　　者：杨志勇 魏晶晶[1] 庄则豪[1] YANG Zhi-yong;WEI Jing-jing;ZHUANG Ze-hao(Department of Gastrointestinal Endoscopy,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,Fujian,China)

机构地区：[1]福建医科大学附属第一医院消化内镜中心,福州350005

出　　处：《肿瘤代谢与营养电子杂志》2018年第2期139-143,共5页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：福建省科技计划项目(2014Y1002)

摘　　要：内镜下或影像学引导的非外科空肠造口技术是建立肿瘤患者肠内营养治疗通路的重要手段,尤其对胃切除术后、有高误吸风险和胃动力障碍的患者有益。中国抗癌协会肿瘤营养与支持治疗专业委员会肿瘤营养通路学组发布的《中国恶性肿瘤营养治疗通路专家共识(2018)》提出了应用此项技术的临床实践推荐意见。本文从直接和间接法经皮内镜下空肠造口的技术特点、置管部位选择和定位手段进展,X线及超声引导在空肠造口中的应用以及多技术联合应用的实践证据等方面对共识意见中的相关内容进行介绍,特别对胃瘫、胃内喂养不耐受、胃流出道梗阻等不适合接受经皮胃造口的患者使用直接或间接法经皮内镜下空肠造口建立肠内营养通路的选择策略;直接法经皮内镜下空肠造口的技术难点和新近出现的技术改良手段;X线辅助经皮空肠造口以及X线辅助经皮内镜下空肠造口的技术进展和临床意义;单气囊或双气囊小肠镜对提高直接法经皮内镜下空肠造口成功率的积极意义等进行了相关文献回顾与解读。Non-surgical jejunostomy,including endoscopic and iconographic guided jejunostomy is an important method for enteral nutrition access establishment,which is especially beneficial to the patients with gastrectomy,high risk of aspiration or gastric dysmotility.“Chinese experts consensus on nutritional access of cancer patients(2018)”,which was released by the the Nutritional Access Group of Chinese Society for Oncological Nutrition and Supportive Care,suggested several recommendations on nonsurgical jejunostomy.Here we provide further related information for the recommendations,including the technical characteristics of percutaneous endoscopic gastrojejunostomy and direct percutaneous endoscopic jejunostomy,the advanced modification on localization techniques of tube placement and puncturing site selection,the updated evidences on clinical application of sonographic/radiologic jejunostomy and combined techniques.We also previewed related literatures and interpret the optional strategy of percutaneous endoscopic gastrojejunostomy or direct percutaneous endoscopic jejunostomy in patients who are unsuitable for percutaneous gastrostomy,the technological difficulties and resolutions in direct percutaneous endoscopic jejunostomy,the technical progress and clinical significance of radiologic application in non-surgical jejunostomy,and the positive role of single-balloon enteroscopy or double-balloon enteroscopy in improving the success rate of direct percutaneous endoscopic jejunostomy.

关 键 词：肠内营养 空肠造口 消化内镜 肿瘤营养 放射影像学 

分 类 号：R730.5[医药卫生—肿瘤] R459.3[医药卫生—临床医学]