营养治疗在肠外瘘病人中的应用及临床价值  

Application and clinical value of nutritional support therapy in patients with enterocutaneous fistula

作　　者：杨帆 王新颖 YANG Fan;WANG Xin-ying(Department of General Surgery,Jinling Hospital(General Hospital of Eastern Theater Command)Affiliated to Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)普通外科,江苏南京210002

出　　处：《中国实用外科杂志》2025年第3期294-298,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82170575,No.82370900);江苏省医学创新中心项目(No.CXZX202217)。

摘　　要：肠外瘘是胃肠外科的一种急危重症,通常由手术创伤、感染、炎性肠病或恶性肿瘤等引发。该病症的进展常伴随高分解代谢、负氮平衡、营养不良及电解质失衡,严重影响病人的临床预后并加重病死率。精确的营养治疗能够满足病人的能量与营养需求,并调节全身代谢状态,促进组织修复与增强免疫功能。营养治疗的阶段性支持对病人恢复至关重要,分为感染期、带瘘生存期和围手术期三大阶段。各阶段的营养策略分别聚焦于感染控制、电解质平衡修正、肠内外营养的逐步恢复等,并通过合理的蛋白质与能量摄入促进瘘口愈合与病情稳定。早期的合理营养治疗不仅提升了肠外瘘病人的自愈率,还能够显著降低病死率。特别是在感染期,肠内营养与肠外营养的适时结合能够有效维持病人的营养状态并防止并发症的发生。特定微量元素如锌、硒及免疫营养素(如ω-3脂肪酸和谷氨酰胺)在肠外瘘病人的康复中发挥重要作用。随着技术进步,如3D打印肠瘘支架、功能化生物补片等新兴技术为临床治疗提供了创新的解决方案,将进一步优化个性化治疗策略,并可能提高治疗效果与病人预后。Enterocutaneous fistula(ECF)is a critical emergency in gastrointestinal surgery,typically caused by surgical trauma,infection,inflammatory bowel disease,or malignancy.The progression of this condition is often associated with hypermetabolism,negative nitrogen balance,malnutrition,and electrolyte imbalances,severely affecting clinical outcomes and increasing mortality rates.Accurate nutritional support is essential to meet the patient’s energy and nutritional needs,regulate the systemic metabolic state,promote tissue repair,and enhance immune function.The staged nutritional support treatment is crucial for patients’recovery and is divided into three major phases:the infection phase,the phase of living with the fistula,and the perioperative phase.Nutritional strategies for each stage focus on infection control,correction of electrolyte imbalances,and the gradual restoration of enteral and parenteral nutrition,respectively,with adequate protein and energy intake promoting fistula healing and disease stabilization.Early,appropriate nutritional support not only enhances the selfhealing rate of ECF patients but also significantly reduces mortality.In particular,during the infection phase,a timely combination of enteral and parenteral nutrition effectively maintains the patient’s nutritional status and prevents complications.Specific trace elements such as zinc,selenium,and immune-nutrients(e.g.,ω-3 fatty acids and glutamine)play an essential role in the recovery of ECF patients.With advancements in technology,emerging techniques like 3Dprinted fistula stents and functionalized biological patches provide innovative solutions for clinical treatment,further optimizing personalized treatment strategies and potentially improving treatment outcomes and patient prognosis.

关 键 词：肠外瘘 营养治疗 阶段性治疗 

分 类 号：R459.3[医药卫生—治疗学]