胃癌胃切除术后微量营养素缺乏症的研究进展  

Research progress on micronutrient deficiency after gastrectomy for gastric cancer

作　　者：许兆万 董博[2] XU Zhaowan;DONG Bo(The Fifth Clinical College of Shanxi Medical University,Taiyuan 030001,P.R.China;Department of Gastrointestinal Surgery,Shanxi Provincial People’s Hospital,Taiyuan 030001,P.R.China)

机构地区：[1]山西医科大学第五临床医学院,太原030001 [2]山西省人民医院胃肠外科,太原030001

出　　处：《中国普外基础与临床杂志》2024年第9期1135-1140,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：山西省自然科学基金(项目编号:201901D111440)。

摘　　要：目的了解近年来国内外关于胃癌胃切除术后微量营养素缺乏的研究进展,以期为其预防及治疗提供新的思路。方法检索近年来国内外有关胃癌胃切除术后微量营养素缺乏症相关研究的文献并进行综述。结果微量营养素缺乏症在接受部分或全胃切除术后的胃癌患者中较为常见,尤其是铁、锌、铜、脂溶性维生素(维生素A、D、E)、维生素B12、叶酸等关键营养素的缺乏。其发生原因主要是由于手术对胃肠道解剖结构或生理功能的改变,因为多数微量营养素是通过十二指肠或空肠吸收,全胃或部分胃切除术后绕过了微量营养素的主要吸收部位;此外,术前营养不良、新辅助治疗、术后早期和晚期其他并发症、术后辅助治疗以及胃酸分泌的减少均可能导致一系列微量营养素的吸收障碍。对于胃癌胃切除术后关于微量营养素补充的文献研究相对较少,但是仍有部分研究者支持对于严重营养不良的胃癌患者在手术前后提供营养支持,少有文献报道对接受胃切除术患者进行营养支持的不良后果。结论目前关于胃癌胃切除术后微量营养素缺乏和补充研究的相关文献仍不充分。随着临床医生对微量营养素对疾病或健康影响的关注,2022年欧洲肠外肠内营养学会制定了《ESPEN微量营养素指南》以及2024年我国发布了《恶性肿瘤微量营养素缺乏与补充专家共识》,在当前相关研究较为不足的情况下,建议临床医师参照这些指南或共识并结合临床实际情况对微量营养素缺乏症患者采取个体化的干预措施。Objective To understand the research progress on micronutrient deficiency after gastrectomy for gastric cancer in order to provide a new ideas for its prevention and treatment.Method The literature on reseach relevant micronutrient deficiency after gastrectomy for gastric cancer in recent years at home and abroad was searched and reviewed.Results The micronutrient deficiency after partial or total gastrectomy was more common for the patients with gastric cancer,especially some key nutrients such as iron,zinc,copper,fat soluble vitamins(vitamins A,D,E),vitamin B12,folate,and so on.The main reason for the micronutrient deficiency was due to the changes of the anatomical structure or physiological function of the gastrointestinal tract caused by surgery,as most micronutrients were absorbed through the duodenum or jejunum,bypassing the main absorption site of micronutrients after total or partial gastrectomy;In addition,preoperative malnutrition,neoadjuvant therapy,early and late postoperative complications,as well as postoperative adjuvant therapy,and reduced gastric acid secretion,might all lead to the micronutrient absorption disorders.There was also limited literature on the micronutrient supplementation after gastrectomy for gastric cancer,but some researchers still supported providing nutritional support before and after surgery for the gastric cancer patients with severe malnutrition.There was few literature reported on the adverse consequences of nutritional support for the gastric cancer patients underwent gastrectomy.Conclusions At present,there is still limited literature on the study of micronutrient deficiency and supplementation after gastrectomy for gastric cancer.With the increasing attention of clinician to the impact of micronutrients on diseases or health,the European Society for Extraintestinal and Enteral Nutrition developed the“ESPEN micronutrition guidelines”in 2022 and“Expert consensus on micronutrients deficiency and supplementation in malignant tumors”was published in China at 2024.I

关 键 词：胃癌 胃切除术 微量营养素缺乏症 

分 类 号：R735.2[医药卫生—肿瘤]