中国实用外科杂志

中国实用外科杂志

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胰腺癌病人围手术期营养支持要点

孙    备，田凤宇   

  1. 哈尔滨医科大学附属第一医院胰胆外科，黑龙江哈尔滨150081
  • 出版日期:2018-03-01 发布日期:2018-03-06

  • Online:2018-03-01 Published:2018-03-06

摘要：

胰腺癌病人发生围手术期营养不良的风险极高，而围手术期营养不良的发生将严重影响病人预后。一方面，术前营养状态差将影响手术时机的抉择、增加术后并发症发生的风险；另一方面，术后短期内营养状态差可导致住院时间延长、术后并发症发生率及病死率增加。长期的营养不良对病人生存质量及生存时间带来巨大负面影响。因而建议：（1）当体重下降＞10%（血浆白蛋白＜30 g/L）时，考虑推迟手术，并给予强化营养支持治疗，同时动态监测营养状态。（2）当体重下降5%～10%时，仍建议营养支持先于手术的治疗策略，对可切除胰腺癌病人密切监测营养状态，选择最佳手术时机，实现R0切除。（3）术后可依据加速康复外科理念给予营养支持，以实现快速康复，帮助病人进入下一阶段治疗。（4）术后应重视对胰腺外分泌功能不全的诊断及治疗。

关键词: 胰腺癌, 围手术期, 营养支持, 胰腺外泌功能不全

Abstract:

Key points of perioperative nutritional support for patients with pancreatic cancer        SUN Bei, TIAN Feng-yu. Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150081, China
Corresponding author: SUN Bei, E-mail：sunbei70@tom.com
Abstract    The risk of perioperative malnutrition is very high in patients with pancreatic cancer， and the occurrence of malnutrition in the perioperative period will seriously affect the prognosis of the patients. On the one hand， poor preoperative nutritional status will affect the timing of surgery and increase the risk of postoperative complications. On the other hand， short-term poor nutritional status can lead to prolonged hospitalization，increase postoperative morbidity and mortality. Long-term malnutrition has a great negative impact on the quality of life and the survival time of the patients. Therefore， it suggests that：（1） When the weight loss ＞10% （albumin ＜30g/L）， consider postponing surgery， and to give enhanced nutritional support therapy， and monitor the nutritional status；（2）When the weight loss between 5% and 10%， treatment strategies still stand for nutritional support before surgery. For resectable pancreatic cancer， monitor the nutritional status closely and select the optimal timing of surgery to achieve R0 resection；（3）Enhanced recovery after surgery management is recommended after surgery to achieve rapid recovery；（4）Pay attention to the diagnosis and treatment of pancreatic exocrine insufficiency after surgery.

Key words: pancreatic cancer, perioperative period, nutritional support, exocrine pancreatic insufficiency