腹膜后脂肪肉瘤围手术期营养管理一例  

A case of perioperative nutritional management in retroperitoneal dedifferentiated liposarcoma

作　　者：王芳[1] 果建朋 郭长月 WANG Fang;GUO Jianpeng;GUO Changyue(Department of Retroperitoneal Tumor Surgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院腹膜后肿瘤外科,北京102206

出　　处：《中国研究型医院》2024年第1期70-73,共4页Chinese Research Hospitals

摘　　要：患者男,因自行扪及上腹部肿块1个月,进食少3个月,于2023年3月7日就诊。综合病史、体征、实验室及影像检查结果,确诊为腹膜后脂肪肉瘤(去分化脂肪肉瘤)。因3个月内行2次开腹手术,故患者的围手术期营养管理尤为重要。基于营养评估,患者的营养管理分3个阶段,(1)手术前营养:采用口服营养补充+部分肠外营养支持模式,纠正电解质紊乱、低蛋白血症等,以提升患者手术耐受力;(2)手术后禁食期间:采用全肠外营养支持模式护理,关注电解质、相关营养指标及肠道功能,尽早开启肠内营养;(3)术后肠瘘阶段:采用序贯营养支持方案,选择合适的肠内营养制品,并循序渐进增加肠内营养的摄入量;经过70 d的治疗与护理,患者完全恢复经口进食,5月17日出院。腹膜后脂肪肉瘤是一类发生于腹膜后区域的罕见恶性肿瘤,瘤体通常较大,手术后并发症较多,而患者营养管理与术后转归密切相关。The patient,a male,presented on March 7,2023,with a self-palpable abdominal mass for 1 month and decreased appetite for 3 months.Based on comprehensive medical history,physical examination,laboratory and imaging results,he was diagnosed with retroperitoneal dedifferentiated liposarcoma.Because the patient has undergone 2 laparotomies within the past three months.Perioperative nutritional management is crucial.Considering the nutritional assessment,the patient's nutritional management is divided into three stages:(1)preoperative nutrition:oral nutritional supplements and partial parenteral nutrition to correct electrolyte imbalances and hypoproteinemia,aiming to improve the patient's surgical tolerance;(2)nil peros postoperative:phase total parenteral nutrition is used to focus on electrolytes,nutritional indicators,and intestinal function,with an early initiation of enteral nutrition;(3)postoperative phase with concurrent intestinal fistula:a sequential nutritional support plan is adopted,selecting appropriate enteral nutrition products and gradually increasing the intake of enteral nutrition.After 70 days of treatment and care,the patient fully recovered oral intake and was discharged on May 17.Retroperitoneal dedifferentiated liposarcoma is a rare malignant tumor that occurs in the retroperitoneal region,often with a large tumor size and numerous postoperative complications.Patient nutritional management is closely related to postoperative outcomes.

关 键 词：腹膜后脂肪肉瘤 围手术期 营养管理 

分 类 号：R735.4[医药卫生—肿瘤]