食管癌患者围手术期规范化营养治疗现状

doi:10.3760/cma.j.issn.1007-1245.2024.09.007

国际医药卫生导报 ›› 2024, Vol. 30 ›› Issue (9): 1434-1439.DOI: 10.3760/cma.j.issn.1007-1245.2024.09.007

食管癌患者围手术期规范化营养治疗现状

余思燕¹ 高玲² 许鹏¹ 黄瑜芳¹

¹广州医科大学附属肿瘤医院临床营养科，广州　510095；²广州医科大学附属肿瘤医院干部保健病区，广州　510095

收稿日期:2023-09-07 出版日期:2024-05-01 发布日期:2024-05-30
通讯作者: 黄瑜芳，Email：785331292@qq.com
基金资助:
广东省肿瘤防治筛查及科普宣教公益项目（JZ2021015）

Standardized nutrition therapy for patients with esophageal cancer during perioperative period

Yu Siyan¹, Gao Ling², Xu Peng¹, Huang Yufang¹

¹Department of Clinical Nutrition, Cancer Hospital & Institute Affiliated to Guangzhou Medical University, Guangzhou 510095, China; ²Health Care Ward, Cancer Hospital & Institute Affiliated to Guangzhou Medical University, Guangzhou 510095, China

Received:2023-09-07 Online:2024-05-01 Published:2024-05-30
Contact: Huang Yufang, Email: 785331292@qq.com
Supported by:
Cancer Prevention and Treatment Screening and Science Popularization Education Public Welfare Project in Guangdong (JZ2021015)

摘要/Abstract

摘要：

食管癌患者是营养不良的高发人群。营养治疗对提高食管癌手术患者手术耐受性、改善临床结局以及患者的生活质量等具有重要意义，而开展规范化的营养治疗更是能及早并有效让食管癌围手术期患者从中获益。本文对食管癌围手术期患者的营养治疗现状、规范化营养治疗的重要性以及规范化营养治疗的具体内容进行综述，并分析不合理应用营养治疗的潜在原因及解决办法，旨在提高临床医护人员对食管癌患者围手术期规范化营养治疗的认识和临床应用力度，以期更好地促进患者术后康复、提高生活质量。

关键词:

食管癌, 围手术期, 营养治疗, 规范, 现状

Abstract:

Patients with esophageal cancer are at high risk of malnutrition. Nutritional therapy is of great significance in improving the surgical tolerance, clinical outcomes, and quality of life of patients undergoing surgery for esophageal cancer. Standardized nutritional therapy can benefit patients with esophageal cancer during perioperative period as early as possible. This review summarizes the status quo of perioperative nutritional therapy for patients with esophageal cancer, the importance of standardized nutritional therapy, and its contents. And we also analyze the potential causes and solutions of unreasonable application of nutritional therapy. The paper aims at improving the understanding of medical staff and clinical application of standardized nutritional therapy in patients with esophageal cancer during perioperative period, so as to promote the patients' postoperative recovery and improve their quality of life.

Key words:

Esophageal cancer, Perioperative period, Nutrition therapy, Standardized medical treatment, Present situation

余思燕高玲许鹏黄瑜芳.

食管癌患者围手术期规范化营养治疗现状 [J]. 国际医药卫生导报, 2024, 30(9): 1434-1439.

Yu Siyan, Gao Ling, Xu Peng, Huang Yufang.

Standardized nutrition therapy for patients with esophageal cancer during perioperative period [J]. International Medicine and Health Guidance News, 2024, 30(9): 1434-1439.

参考文献

[1] Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J (Engl), 2021,134(7):783-791. DOI: 10.1097/CM9.0000000000001474.
[2] Takeuchi H, Ikeuchi S, Kawaguchi Y, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer[J]. World J Surg, 2007,31(11):2160-2167. DOI: 10.1007/s00268-007-9219-8.
[3] 黎介寿.改进"围手术期处理"提高外科治疗质量[J].肠外与肠内营养,2018,25(1):1-2,6.DOI:10.16151/j.1007-810x.2018.01.001.
[4] Al-Shammari L, Douglas D, Gunaratnam G, et al. Perioperative medicine: a new model of care?[J]. Br J Hosp Med (Lond), 2017,78(11):628-632. DOI: 10.12968/hmed.2017.78.11.628.
[5] Song C, Cao J, Zhang F, et al. Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23,904 common malignant tumors patients[J]. Nutr Cancer, 2019,71(1):50-60. DOI: 10.1080/01635581.2019.1566478.
[6] Bozzetti F, Mariani L, Lo Vullo S;et al. The nutritional risk in oncology: a study of 1,453 cancer outpatients[J]. Support Care Cancer, 2012,20(8):1919-1928. DOI: 10.1007/s00520-012-1387-x.
[7] Cong MH, Li SL, Cheng GW, et al. An interdisciplinary nutrition support team improves clinical and hospitalized outcomes of esophageal cancer patients with concurrent chemoradiotherapy[J]. Chin Med J (Engl), 2015,128(22):3003-3007. DOI: 10.4103/0366-6999.168963.
[8] Zhang S, Tan Y, Cai X, et al. Preoperative weight loss is associated with poorer prognosis in operable esophageal cancer patients: a single-center retrospective analysis of a large cohort of Chinese patients[J]. J Cancer, 2020,11(7):1994-1999. DOI: 10.7150/jca.40344.
[9] Pan P, Tao G, Sun X. Subjective global assessment and prealbumin levels of esophageal cancer patients undergoing concurrent chemoradiotherapy[J]. NutrHosp, 2015,31(5):2167-2173. DOI: 10.3305/nh.2015.31.5.8596.
[10] Pan H, Cai S, Ji J, et al. The impact of nutritional status, nutritional risk, and nutritional treatment on clinical outcome of 2248 hospitalized cancer patients: a multi-center, prospective cohort study in Chinese teaching hospitals[J]. Nutr Cancer, 2013,65(1):62-70. DOI: 10.1080/01635581.2013.741752.
[11] 刘春芳,王万霞,顾侠,等.护理营养干预对食管癌病人术后营养状况的影响[J].蚌埠医学院学报,2018,43(4):537-539.DOI:10.13898/j.cnki.issn.1000-2200. 2018.04.033.
[12] Steenhagen E, van Vulpen JK, van Hillegersberg R, et al. Nutrition in peri-operative esophageal cancer management[J]. Expert Rev GastroenterolHepatol, 2017,11(7):663-672. DOI: 10.1080/17474124.2017.1325320.
[13] Carr RA, Harrington C, Stella C, et al. Early implementation of a perioperative nutrition support pathway for patients undergoing esophagectomy for esophageal cancer[J]. Cancer Med, 2022,11(3):592-601. DOI: 10.1002/cam4.4360.
[14] Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients[J]. ClinNutr, 2017,36(1):11-48. DOI: 10.1016/j.clnu.2016.07.015.
[15] Cao J, Xu H, Li W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer[J]. CurrProbl Cancer, 2021,45(1):100638. DOI: 10.1016/j.currproblcancer.2020.100638.
[16] 宋春花,王昆华,郭增清,等. 中国常见恶性肿瘤患者营养状况调杳[J]. 中国科学(生命科学),2020,50(12):1437-1452. DOI:10.1360/SSV-2020-0297.
[17] Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery[J]. ClinNutr, 2017,36(3):623-650. DOI: 10.1016/j.clnu.2017.02.013.
[18] Cao Y, Han D, Zhou X, et al. Effects of preoperative nutrition on postoperative outcomes in esophageal cancer: a systematic review and meta-analysis[J]. Dis Esophagus, 2022,35(3):doab028. DOI: 10.1093/dote/doab028.
[19] Shen Y, Zhou Y, He T, et al. Effect of preoperative nutritional risk screening and enteral nutrition support in accelerated recovery after resection for esophageal cancer[J]. Nutr Cancer, 2021,73(4):596-601. DOI: 10.1080/01635581.2020.1764981.
[20] 李燕,程垚,徐斌,等. 食管癌患者术前营养风险评估与干预的效果评价[J]. 中华护理杂志,2015,50(2):166-170. DOI:10.3761/j.issn.0254-1769.2015.02.009.
[21] Wang R, Cai H, Li Y, et al. Impact exerted by nutritional risk screening on clinical outcome of patients with esophageal cancer[J]. Biomed Res Int, 2018,2018:7894084. DOI: 10.1155/2018/7894084.
[22] 周海英,吴爱萍,陈银苹.术前肠内营养对食管癌病人术后营养状况的影响分析[J].中国实用外科杂志,2010,30(2):133-134.
[23] 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会肿瘤康复与姑息治疗专业委员会,等. 肿瘤营养治疗通则[J/CD]. 肿瘤代谢与营养电子杂志,2016,3(1):28-33.DOI:10.16689/j.cnki.cn11-9349/r.2016.01.009.
[24] 韩东景,赵楠,李伟,等.食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查[J].中华肿瘤防治杂志,2013,20(16):1274-1278.DOI:10.16073/j.cnki.cjcpt.2013.16.018.
[25] 李子建,赵彬,何桂珍,等.北京多中心住院患者肠外营养支持应用现状调查[J]. 中华临床营养杂志,2015,23(6):336-340. DOI:10.3760/cma.j.issn.1674-635X.2015.06.003.
[26] 李涛,李宝生,吕家华,等.食管癌患者营养治疗指南[J/CD]. 肿瘤代谢与营养电子杂志,2020,7(1):32-42. DOI:10.16689/j.cnki.cn11-9349/r.2020.01.007.
[27] Han H, Pan M, Tao Y, et al. Early enteral nutrition is associated with faster post-esophagectomy recovery in Chinese esophageal cancer patients: a retrospective cohort study[J]. Nutr Cancer, 2018,70(2):221-228. DOI: 10.1080/01635581.2018.1412477.
[28] Peng J, Cai J, Niu ZX, et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis[J]. Dis Esophagus, 2016,29(4):333-341. DOI: 10.1111/dote.12337.
[29] Perinel J, Mariette C, Dousset B, et al. Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy: a randomized multicenter controlled trial (Nutri-DPC)[J]. Ann Surg, 2016,264(5):731-737. DOI: 10.1097/SLA.0000000000001896.
[30] 李爽,王立伟,胡文滕,等. 早期肠内营养和肠外营养治疗食管癌术后患者临床疗效的Meta分析[J]. 中国循证医学杂志,2016,16(10):1176-1182. DOI:10.7507/1672-2531. 20160179.
[31] 王庆淮,谭宁,滕泽林. 食管癌术后早期肠内营养治疗的研究进展[J]. 国际医药卫生导报,2012,18(18):2661-2664. DOI:10.3760/cma.j.issn.1007-1245.2012.18.006.
[32] Fujita T, Daiko H, Nishimura M. Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer[J]. EurSurg Res, 2012,48(2):79-84. DOI: 10.1159/000336574.
[33] 于振涛. 食管癌术后营养支持的研究进展[J]. 中国肿瘤临床,2014(23):1479-1483. DOI:10.3969/j.issn.1000-8179.20141718.
[34] Zheng R, Devin CL, Pucci MJ, et al. Optimal timing and route of nutritional support after esophagectomy: a review of the literature[J]. World J Gastroenterol, 2019,25(31):4427-4436. DOI: 10.3748/wjg.v25.i31.4427.
[35] Wang G, Chen H, Liu J, et al. A comparison of postoperative early enteral nutrition with delayed enteral nutrition in patients with esophageal cancer[J]. Nutrients, 2015,7(6):4308-4317. DOI: 10.3390/nu7064308.
[36] 齐玉梅,马旭东,刘先夺,等. 全国医疗机构临床营养医疗服务与质量安全调研[J]. 中国卫生质量管理,2021,28(11):34-36,40. DOI:10.13912/j.cnki.chqm.2021.28.11.08.
[37] 医政医管局.国家卫生健康委办公厅关于印发临床营养科建设与管理指南(试行)的通知(2022-3-25)[2023-9-7]. http://www.nhc.gov.cn/yzygj/s7659/202203/106295a75d5e426991616dc0f201b847.shtml
[38] 医政司.国家卫生健康委办公厅关于印发医疗质量控制中心管理规定的通知(2022-2-27)[2023-9-7]. http://www.nhc.gov.cn/yzygj/s7657/202302/9af9dfc9479040a1994563a35c453ef8.shtml
[39] 张晓伟,程雪娇,石汉平.医务人员肿瘤营养知识-态度-行为现状及既往对比分析[J/CD].肿瘤代谢与营养电子杂志,2021,8(4):393-397.
[40] 张晓伟,李薇,陈公琰,等.中国肿瘤患者营养知识—态度—行为调查分析[J/CD].肿瘤代谢与营养电子杂志,2015,2(4):43-47.DOI:10.16689/j.cnki.cn11-9349/r.2015. 04.020.
[41] 邢丽华. 食管癌患者家庭照顾者营养认知水平与照顾质量的相关性研究[D].郑州:河南大学,2021.DOI:10.27114/d.cnki.ghnau.2020.001375.
[42] 李苏宜,张小田,丛明华,等. 规范化肿瘤营养治疗示范病房标准[J/CD]. 肿瘤代谢与营养电子杂志,2019,6(1):35-40. DOI:10.16689/j.cnki.cn11-9349/r.2019.01.006.
[43] 石汉平. 肿瘤营养疗法[J]. 中国肿瘤临床,2014,41(18):1141-1145. DOI:10.3969/j.issn.1000-8179.20141379.
[44] Schuetz P, Fehr R, Baechli V, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial[J]. Lancet, 2019,393(10188):2312-2321. DOI: 10.1016/S0140-6736(18)32776-4.
[45] 于恺英,冯彩云,陈永兵,等. 肿瘤营养诊疗系统的实施与应用[J/CD]. 肿瘤代谢与营养电子杂志,2020,7(3):358-361. DOI:10.16689/j.cnki.cn11-9349/r.2020.03.020.
[46] 中国抗癌协会肿瘤营养专业委员会,中华医学会肠外肠内营养学分会,中国医师协会放射肿瘤治疗医师分会营养与支持治疗学组. 食管癌患者营养治疗指南[J]. 中国肿瘤临床,2020,47(1):1-6,中插1-中插4. DOI:10.3969/j.issn.1000-8179.2020.01.430.
[47] 国家卫生健康委员会.食管癌诊疗规范(2018年版)[J/CD]. 肿瘤综合治疗电子杂志,2019,5(2):50-86. DOI:10.12151/JMCM.2019.02-11.
[48] Chen MJ, Wu IC, Chen YJ, et al. Nutrition therapy in esophageal cancer-consensus statement of the Gastroenterological Society of Taiwan[J]. Dis Esophagus, 2018,31(8). DOI: 10.1093/dote/doy016.
[49] Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: clinical nutrition in surgery[J]. ClinNutr, 2021,40(7):4745-4761. DOI: 10.1016/j.clnu.2021.03.031.
[50] 中国临床肿瘤学会. 恶性肿瘤患者营养治疗指南2021[M]. 北京:人民卫生出版社, 2021.
[51] Patel JJ, Martindale RG, McClave SA. Controversies surrounding critical care nutrition: an appraisal of permissive underfeeding, protein, and outcomes[J]. JPEN J Parenter Enteral Nutr, 2018,42(3):508-515. DOI: 10.1177/0148607117721908.
[52] 洪耿德,方楠,邓颖,等. 免疫营养在食管癌围术期应用的研究现状[J]. 国际医药卫生导报,2022,28(3):439-444. DOI:10.3760/cma.j.issn.1007-1245.2022.03.034.
[53] 石汉平,王昆华,徐希平.价值营养治疗——从价值医疗看临床营养[J/CD].肿瘤代谢与营养电子杂志,2021,8(6):569-575.
[54] 中华医学会肠外肠内营养学分会.成人口服营养补充专家共识[J].中华胃肠外科杂志,2017,20(4):361-365.DOI:10.3760/cma.j.issn.1671-0274.2017.04.001.
[55] 赵彬,老东辉,商永光,等.规范肠外营养液配制[J].中华临床营养杂志,2018,26(3):136-148.DOI:10.3760/cma.j.issn.1674-635X.2018.03.002.
[56] de Vasconcellos Santos FA, Torres Júnior LG, Wainstein AJA, et al. Jejunostomy or nasojejunal tube after esophagectomy: a review of the literature[J]. J Thorac Dis, 2019,11 Suppl 5:S812-S818. DOI: 10.21037/jtd.2018.12.62.
[57] Zheng Y, Li Y, Wang Z, et al. A video demonstration of the Li's anastomosis-the key part of the "non-tube no fasting" fast track program for resectable esophageal carcinoma[J]. J Thorac Dis, 2015,7(7):1264-1268. DOI: 10.3978/j.issn.2072-1439.2015.07.07.
[58] Li X, Yan S, Ma Y, et al. Impact of early oral feeding on anastomotic leakage rate after esophagectomy: a systematic review and meta-analysis[J]. World J Surg, 2020,44(8):2709-2718. DOI: 10.1007/s00268-020-05489-z.
[59] 石汉平. 营养治疗的疗效评价[J/CD]. 肿瘤代谢与营养电子杂志,2017,4(4):364-370. DOI:10.16689/j.cnki.cn11-9349/r.2017.04.001.

食管癌患者围手术期规范化营养治疗现状

Standardized nutrition therapy for patients with esophageal cancer during perioperative period

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	劳凯雪艾丁丁丁培辉苏哲李晓冉王雁林. 住院医师规范化培训与临床实习一体化培养模式下研究生教育情况调查 [J]. 国际医药卫生导报, 2024, 30(9): 1538-1542.
[2]	任塞红安晓燕艾苗苗封帆. 赋权激励干预模式在口腔颌面日间手术患者中的应用效果 [J]. 国际医药卫生导报, 2024, 30(9): 1564-1569.
[3]	吴侨侨. 老年患者麻醉术前评估的研究进展 [J]. 国际医药卫生导报, 2024, 30(6): 946-948.
[4]	张蕙艳蒋蕾周楠. 基于生物-心理-社会系统的共情技术在颅内动脉瘤围手术期的作用 [J]. 国际医药卫生导报, 2024, 30(6): 1038-1043.
[5]	李晓梦仝小娟李梦. 快速康复外科在微创经椎间孔椎间融合术围手术期的应用价值 [J]. 国际医药卫生导报, 2024, 30(6): 1047-1051.
[6]	范玉云周梦雯卢春丽肖华. 饮食日记营养管理在脊柱结核患者围手术期中的应用 [J]. 国际医药卫生导报, 2024, 30(6): 1052-1056.
[7]	甘喆李桂贤董寒星. 基于双相交流的健康宣教干预在ERCP患者围手术期护理中的应用 [J]. 国际医药卫生导报, 2024, 30(4): 670-673.
[8]	徐海霞罗海霞卓冬砚李亚伟周迎光. 揿针结合冰硝散在踝关节骨折患者围手术期中的应用效果 [J]. 国际医药卫生导报, 2024, 30(3): 443-448.
[9]	李玉秋叶晓芳. 血栓弹力图指导的输血应用于体外循环心脏手术围手术期的效果 [J]. 国际医药卫生导报, 2023, 29(9): 1268-1271.
[10]	周伟君田天照施敏蔡迎峰周剑鹏. MIS-TLIF围手术期中西医结合外科快速康复理念的实践运用 [J]. 国际医药卫生导报, 2023, 29(8): 1127-1131.
[11]	吴敏于娜王凌云薛凌黄烁傅特. 近视青少年佩戴角膜接触镜的横断面调查研究 [J]. 国际医药卫生导报, 2023, 29(6): 807-813.
[12]	刘辉王珍珍赵亚非. 临床药师参与的用药管理对急性脑梗死介入术后患者用药规范性、用药依从性及安全性的影响 [J]. 国际医药卫生导报, 2023, 29(4): 564-568.
[13]	徐莹莹崔莹莹. 循证理论的手术室责任制护理在甲状腺手术患者中的应用效果 [J]. 国际医药卫生导报, 2023, 29(24): 3585-3589.
[14]	熊辉强潘鸿桂曹小青甘文鹉. 加速康复外科在耳内镜下鼓膜修补术围手术期的应用研究 [J]. 国际医药卫生导报, 2023, 29(23): 3399-3402.
[15]	郁济王晓颖. 规范化管理住院病案首页信息在DRGs准确分组中的应用价值 [J]. 国际医药卫生导报, 2023, 29(22): 3250-3253.