损伤控制性手术下肠内营养改善癌性肠梗阻患者营养状况的进展  

Damage control surgery combined with enteral nutrition improve the nutritional status of patients with cancerous intestinal obstruction

作　　者：张瑞鹏 王璐 孙明伟 Zhang Ruipeng;Wang Lu;Sun Mingwei(Institute for Emergency and Disaster Medicine,Sichuan Clinical Research Center for Emergency and Critical Care,Sichuan Provincial,People's Hospital Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,Sichuan,China)

机构地区：[1]急诊医学与灾难医学研究所,四川省急危重症临床医学研究中心,电子科技大学附属医院·四川省人民医院,四川成都610072

出　　处：《肿瘤代谢与营养电子杂志》2024年第2期164-168,共5页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：四川省科技厅重点研发项目(2021YFS0378);四川省干保委重点研发项目(川干研ZH2023-202)。

摘　　要：营养风险在肿瘤患者中普遍存在。由于肿瘤本身的快速生长和代谢活动导致机体需要更多的能量和营养物质,且一些治疗手段如手术、放疗和化疗也会进一步加重代谢负担,如遇到继发于胃肠道恶性肿瘤的肠梗阻,患者营养摄入进一步受到限制,营养不良发生率上升。营养不良会降低身体功能、增加感染和并发症风险,使术后康复变得更加困难。在营养不良所致整体功能下降时行手术治疗会进一步增加患者的病死率。目前针对癌性肠梗阻患者的治疗方案主要以外科手术为主,但营养不良会增加这类患者的术后病死率。因此,先行改善患者营养状况成为治疗癌性肠梗阻患者的关键点。采用损伤控制性手术联合肠内营养对改善癌性肠梗阻患者营养状况更为合适。可以先通过内镜下肠梗阻导管置入或肠道自膨胀金属支架等技术解决肠梗阻问题,开通营养通路,改善患者营养状况,架起限期根治手术间的桥梁,改善患者预后。Malnutrition is common in cancer patients.Due to the rapid growth and metabolic activity of tumors themselves,the body requires more energy and nutrients,and some treatment methods such as surgery,radiation therapy,and chemotherapy can further increase the metabolic burden.Intestinal obstruction can be found in gastrointestinal malignancies patients.Patients'intake is further restricted,and the incidence of malnutrition increases.Malnutrition can reduce physical function,increase the risk of infection and complications,and harder postoperative recovery.Surgical treatment in cases of overall functional decline caused by malnutrition will further increase the mortality rate of patients.At present,surgical treatment is the main treatment option for patients with cancerous ileus.However,malnutrition will increase the postoperative mortality of these patients.Therefore,improving the nutritional status of patients has become the key point in the treatment of patients with cancerous intestinal obstruction.Damage control surgery combined with enteral nutrition is more suitable for improving the nutritional status of patients with cancerous intestinal obstruction.Intestinal obstruction can be solved via decompression tubes or self-expanding metal stents under gastrointestinal endoscopy to open nutritional access,improve the nutritional status of patients,build a bridge between radical surgery within a limited period,and improve the prognosis of patients.

关 键 词：损伤控制性手术 癌性肠梗阻 营养不良 

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