《中国恶性肿瘤营养治疗通路专家共识（2018）》解读：外科空肠造瘘

doi:10.16689/j.cnki.cn11-9349/r.2020.02.004

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摘要恶性肿瘤患者大多处于营养不良状态，尤其是消化道肿瘤患者。由于上消化道肿瘤患者多伴长期进食受限，肿瘤本身的消耗，加上手术创伤性应激反应以及术后短期内需要禁食，患者全身营养情况将进一步恶化；营养状况的恶化将导致患者围术期并发症增加、住院时间延长，甚至死亡风险增加。因此，对这类患者围术期的营养治疗显得尤为重要。外科空肠造瘘是肠内营养的主要途径之一，它使得上消化道肿瘤患者可以术后早期并长期接受肠内营养，补充患者因进食困难或者长期进食量少所引起的营养不足，从而降低患者术后并发症的发生率及缩短住院时间，提高手术疗效，改善患者临床结局。本文主要从外科空肠造瘘的进展、适应证及并发症等方面介绍目前的研究现状。

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	吴紫祥
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	吴明

关键词 ：营养治疗, 肠内营养, 外科空肠造瘘

Abstract：Most patients with malignant tumors are malnourished， especially patients with digestive tract cancer. Because upper gastrointestinal cancer patients usually have long-term eating restrictions， complicated by the consumption of the tumor itself combined with surgical trauma and the need for fasting within a short period of time after surgery， the systemic nutritional status of patients further deteriorates； this deterioration of nutritional status leads to patients having increased perioperative complications， prolonged hospital stays， and even increased risk of death. Therefore， perioperative nutritional support for such patients is particularly important. Enteral nutrition is the preferred route of nutrition therapy and surgical jejunostomy is one of the main techniques to enable enteral nutrition. Jejunostomy allows patients with upper gastrointestinal cancer to receive early and long-term enteral nutrition after surgery， supplementing nutrition for patients with difficulty eating or postoperative fasting. This nutrition reduces the incidence of postoperative complications and shortens the length of hospital stays， even improving surgical and clinical outcomes. This article mainly describes the current progress， indications and complications of surgical jejunostomy.

Key words： Nutritional support Enteral nutrition Surgical jejunostomy

通讯作者: 吴明，电子邮箱：iwuming22@zju.edu.cn

引用本文:

吴紫祥，王琪，詹天玮，方帅，董灵君，吴明. 《中国恶性肿瘤营养治疗通路专家共识（2018）》解读：外科空肠造瘘[J]. 肿瘤代谢与营养电子杂志, 2020, 7(2): 151-154.
Wu Zixiang， Wang Qi， Zhan Tianwei， Fang Shuai， Dong Lingjun， Wu Ming. Interpretation of Chinese experts consensus on nutritional therapy access of cancer patients: surgical jejunostomy. Electron J Metab Nutr Cancer, 2020, 7(2): 151-154.

1.KUPPINGER D， HARTL W H， BERTOK M， et al. Nutritional screening for risk prediction in patients scheduled for abdominal operations［J］. Br J Surg， 2012， 99（5）: 728-737.
2.MARSHALL K M， LOELIGER J， NOLTE L， et al. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points［J］. Clin Nutr， 2019， 38（2）:644-651.
3.AGARWAL E， FERGUSON M， BANKS M， et al. Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010［J］. Clin Nutr， 2012， 31（1）: 41-47.
4.HEBUTERNE X， LEMARIE E， MICHALLET M， et al. Prevalence of malnutrition and current use of nutrition therapy in patients with cancer［J］. JPEN J Parenter Enteral Nutr， 2014， 38（2）: 196-204.
5.Bozzetti F， Mariani L， Lo V S， et al. The nutritional risk in oncology: a study of 1， 453 cancer outpatients［J］. Support Care Cancer， 2012， 20（8）: 1919-1928.
6.WHEBLE G A， KNIGHT W R， KHAN O A. Enteral vs total parenteral nutrition following major upper gastrointestinal surgery［J］. Int J Surg， 2012， 10（4）: 194-197.
7.WEIJS T J， BERKELMANS G H， NIEUWENHUIJZEN G A， et al. Routes for early enteral nutrition after esophagectomy. A systematic review［J］. Clin Nutr， 2015， 34（1）: 1-6.
8.YAN X， ZHOU F， LAN T， et al. Optimal postoperative nutrition therapy for patients with gastrointestinal malignancy: A systematic review and meta-analysis［J］. Clin Nutr， 2017， 36（3）: 710-721.
9.BOZZETTI F， BRAGA M， GIANOTTI L， et al. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial［J］. Lancet， 2001， 358（9292）: 1487-1492.
10.LI B， LIU H Y， GUO S H， et al. The postoperative clinical outcomes and safety of early enteral nutrition in operated gastric cancer patients［J］. J BUON， 2015， 20（2）: 468-472.
11.ALLEN J W， ALI A， WO J， et al. Totally laparoscopic feeding jejunostomy［J］.Surg Endosc， 2002， 16（12）: 1802-1805.
12.HAN-GEURTS IJM， LIM A， STIJNEN T， et al. Laparoscopic feeding jejunostomy: A systematic review［J］. Surg Endosc， 2005， 19（7）: 951-957.
13.O’REGAN P J， SCARROW G D. Laparoscopic jejunostomy［J］. Endoscopy， 1990， 22（1）: 39-40.
14.LIU Y Y， LIAO C H， CHEN C C， et al. Single-incision laparoscopic-assisted jejunostomy tube placement［J］. J Laparoendosc Adv Surg Tech A， 2014， 24（1）: 22-27.
15.MOHIUDDIN S S， ANDERSON C E. A novel application for single-incision laparoscopic surgery （SILS）: SIL jejunostomy feeding tube placement［J］. Surg Endosc， 2011， 25（1）: 323-327.
16.MYERS J G， PAGE C P， STEWART R M， et al. Complications of needle catheter jejunostomy in 2，022 consecutive applications［J］. Am J Surg， 1995， 170（6）: 547-550， 550-551.
17.YOUNG M T， TROUNG H， GEBHART A， et al. Outcomes of laparoscopic feeding jejunostomy tube placement in 299 patients［J］.Surg Endosc， 2016， 30（1）: 126-131.
18.BARLOW R， PRICE P， REID T D， et al. Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection［J］. Clin Nutr， 2011， 30（5）: 560-566.
19.TORRES JNIOR L G， DE VASCONCELLOS SANTOS F A， CORREIA MITD. Randomized clinical trial: nasoenteric tube or jejunostomy as a route for nutrition after major upper gastrointestinal operations［J］. World J Surg， 2014， 38（9）: 2241-2246.
20.HAN-GEURTS I J， HOP W C， VERHOEF C， et al. Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy［J］. Br J Surg， 2007， 94（1）: 31-35.
21.GUPTA V. Benefits versus risks: A prospective audit. feeding jejunostomy during esophagectomy［J］. World J Surg， 2009， 33（7）: 1432-1438.
22.RYAN A M， ROWLEY S P， HEALY L A， et al. Post-oesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit［J］. Clin Nutr， 2006， 25（3）: 386-393.
23.GERRITSEN A， BESSELINK M G， GOUMA D J， et al. Systematic review of five feeding routes after pancreatoduodenectomy［J］. Br J Surg， 2013， 100（5）: 589-598， 599.
24.ZHU X， WU Y， QIU Y， et al. Comparative analysis of the efficacy and complications of nasojejunal and jejunostomy on patients undergoing pancreaticoduodenectomy［J］. JPEN J Parenter， 2014， 38（8）: 996-1002.
25.BAKER M， HALLIDAY V， WILLIAMS RN， et al. A systematic review of the nutritional consequences of esophagectomy［J］. Clin Nutr， 2016， 35（5）: 987-994.
26.CAREY S， STOREY D， BIANKIN A V， et al. Long term nutritional status and quality of life following major upper gastrointestinal surgery - A cross-sectional study［J］. Clin Nutr， 2011， 30（6）: 774-779.
27.BOWREY D J， BAKER M， HALLIDAY V， et al. Six weeks of home enteral nutrition versus standard care after esophagectomy or total gastrectomy for cancer: study protocol for a randomized controlled trial［J］. Trials， 2014， 15（1）: 187.
28.GAVAZZI C， COLATRUGLIO S， VALORIANI F， et al. Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: A multicentre randomised clinical trial［J］. Eur J Cancer， 2016， 64: 107-112.
29.王嘉锋，章琎. 空肠造瘘术的并发症［J］. 中国普通外科杂志， 2007（9）: 901-903.