胃癌手术患者肠内营养治疗及肠道微生态调节的研究进展

陈杰; 廉博; 李孟彬; 赵青川

doi:10.16689/j.cnki.cn11-9349/r.2020.01.005

PDF(588 KB)

肿瘤代谢与营养电子杂志 ›› 2020, Vol. 7 ›› Issue (1) : 22-26. DOI: 10.16689/j.cnki.cn11-9349/r.2020.01.005

专家论坛

胃癌手术患者肠内营养治疗及肠道微生态调节的研究进展

陈杰，廉博，李孟彬，赵青川

作者信息 +

Progress of enteral nutrition support and intestinal microecological adjustment in surgical patients with gastric cancer

Chen Jie, Lian Bo, Li Mengbin, Zhao Qingchuan

Author information +

文章历史 +

摘要

胃癌是全球范围内发病率第5位、死亡率第3位的恶性肿瘤；对于有手术机会的胃癌患者主要的治疗方案仍是手术切除，由于胃癌患者精神心理因素、肿瘤消耗、机械梗阻、分解代谢增加等因素会导致患者严重的营养代谢问题，继而影响手术的安全性以及术后康复。外科手术是胃癌最主要的治疗方式，但由手术带来的创伤、生理结构的改变，以及术后的化疗则进一步加重上述问题。肠道微生态是人体免疫功能等重要组成部分，而现有研究提示肿瘤代谢、外科手术、化疗等均可能造成肠道菌群的改变。随着加速康复外科理念的发展，胃癌的综合治疗越来越为外科医生所重视。如何改善患者胃癌术后身体营养状况、减轻肠道菌群紊乱，进而减少术后并发症、加快术后康复，已成为胃肠外科医生关注的重点。本文主要通过文献回顾对行胃癌患者围术期肠内营养治疗及肠道微生态调节的应用进行综述。

Abstract

Gastric cancer is the fifth malignant tumor in incidence and the third in mortality worldwide. For gastric cancer patients, the main treatment plan is still surgical resection. Due to psychological factors, tumor consumption, mechanical obstruction, increased catabolic metabolism and other factors of gastric cancer will lead to serious nutritional metabolism problems among patients, it will affect the safety of surgery and postoperative recovery. Surgery is the main treatment for gastric cancer, but the trauma, physiological changes and postoperative chemotherapy may further aggravate the above problems. Intestinal microecology is an important part of human immune function. However, existing studies suggest that tumor metabolism, surgery and chemotherapy may cause changes in the intestinal flora. With the development of the concept of accelerated rehabilitation surgery, the comprehensive treatment of gastric cancer has attracted more and more attention from surgeons. How to improve the nutritional status of patients with gastric cancer after surgery, reduce intestinal flora disorder, and thus reduce postoperative complications and accelerate postoperative recovery has become the focus of gastrointestinal surgeons. This paper reviews the application of perioperative enteral nutrition support and intestinal microecological regulation in patients with gastric cancer.

导出引用

陈杰，廉博，李孟彬，赵青川. 胃癌手术患者肠内营养治疗及肠道微生态调节的研究进展[J]. 肿瘤代谢与营养电子杂志. 2020, 7(1): 22-26 https://doi.org/10.16689/j.cnki.cn11-9349/r.2020.01.005

Chen Jie, Lian Bo, Li Mengbin, Zhao Qingchuan. Progress of enteral nutrition support and intestinal microecological adjustment in surgical patients with gastric cancer[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2020, 7(1): 22-26 https://doi.org/10.16689/j.cnki.cn11-9349/r.2020.01.005

参考文献

1.Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018： GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Concer J Clin. 2018；68(6)：394-424.
2.Zilberstein B, Jacob CE, Cecconello I. Gastric cancer trends in epidemiology. Arq Gastroenterol. 2012；49(3)：177-178.
3.Santosh Dulal M, Temitope O, Keku M. Gut Microbiome and Colorectal Adenomas. The Cancer Journal. 2014；20(3)：225-231.
4.Chen H, Chen D, Michiels J, et al. Dietary fiber affects intestinal mucosal barrier function by regulating intestinal bacteria in weaning piglets. Commun Agric Appl Biol Sci. 2013；78(1)：71-78.
5.Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer： preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996；347(9007)：995-999.
6.Ajani A, DAmico TA, Almhanna K, et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016；14(10)：1286-1312.
7.Mabvuure NT, Roman A, Khan OA. Enteral immunonutrition versus standard enteral nutrition for patients undergoing oesophagogastric resection for cancer. Int J Surg. 2013；11(2)：122-127.
8.Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014；383(9927)：1490-1502.
9.Chen X, Yang K, Zhang X, et al. Meta-analysis of preoperative oral nutritional supplements for patients with gastric cancer： East Asian experience. European Journal of Clinical Nutrition. 2019.
10.Ding D, Feng Y, Song B, et al. Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients. Turk J Gastroenterol. 2015；26(2)：181-185.
11.Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017；36(1)：11-48.
12.Okamoto K, Fukatsu K, Hashiguchi Y, et al. Lack of preoperative enteral nutrition reduces gut-associated lymphoid cell numbers in colon cancer patients： a possible mechanism underlying increased postoperative infectious complications during parenteral nutrition. Ann Surg. 2013；258(6)：1059-1064.
13.Ralls MW, Demehri FR, Feng Y, et al. Bacterial nutrient foraging in a mouse model of enteral nutrient deprivation： insight into the gut origin of sepsis. Am J Physiol Gastrointest Liver Physiol. 2016；311(4)：G734-G743.
14.Dissanaike S, Shelton M, Warner K, et al. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care. 2007；11(5)：R114.
15.Bozzetti F, Gianotti L, Braga M, et al. Postoperative complications in gastrointestinal cancer patients： the joint role of the nutritional status and the nutritional support. Clin Nutr. 2007；26(6)：698-709.
16.Turnock A, Calder PC, West AL, et al. Perioperative immunonutrition in well-nourished patients undergoing surgery for head and neck cancer： evaluation of inflammatory and immunologic outcomes. Nutrients. 2013；5(4)：1186-1199.
17.Jeong O, Ryu SY, Jung MR, et al. The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma. Gastric Cancer. 2014；17(2)：324-331.
18.Osland E, Yunus RM, Khan S, et al. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery： a meta-analysis. JPEN Journal of parenteral and enteral nutrition. 2011；35(4)：473-487.
19.Osland EJ, Memon MA. Early postoperative feeding in resectional gastrointestinal surgical cancer patients. World J Gastrointest Oncol. 2010；2(4)：187-191.
20.Chen W, Zhang Z, Xiong M, et al. Early enteral nutrition after total gastrectomy for gastric cancer. Asia Pac J Clin Nutr. 2014；23(4)：607-611.
21.Li B, Liu HY, Guo SH, et al. Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer. Genet Mol Res. 2015；14(2)：7136-7141.
22.Wang J, Zhao J, Zhang Y, et al. Early enteral nutrition and total parenteral nutrition on the nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy. Exp Ther Med. 2018；16(1)：321-327.
23.Ma CJ, Wu JM, Tsai HL, et al. Prospective double-blind randomized study on the efficacy and safety of an ω-3 fatty acid enriched intravenous fat emulsion in postsurgical gastric and colorectal cancer patients. Nutr J. 2015；14：9.
24.Wang J, Li Y, Qi Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function, MMP-2, MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy. Oncology Letters. 2017；14(3)：3606-3610.
25.Feijo PM, Rodrigues VD, Viana MS, et al. Effects of omega-3 supplementation on the nutritional status, immune, and inflammatory profiles of gastric cancer patients： A randomized controlled trial. Nutrition. 2019；61：125-131.
26.Lobo DN, Williams RN, Welch NT, et al. Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer： a prospective, randomized, controlled, double-blind study. Clin Nutr. 2006；25(5)：716-726.
27.Short V, Atkinson C, Ness AR, et al. Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery： a qualitative study. Colorectal Dis. 2016；18(2)：O74-O80.
28.Yan X, Zhou FX, Lan T, et al. Optimal postoperative nutrition support for patients with gastrointestinal malignancy： a systematic review and meta-analysis. Clin Nutr. 2017；36(3)：710-721.
29.Cheng Y, Zhang J, Zhang L, et al. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy： a systematic review and meta-analysis. BMC Gastroenterol. 2018；18(1)：11.
30.Li K, Xu Y, Hu Y, et al. Effect of enteral immunonutrition on immune, inflammatory markers and nutritional status in gastric cancer patients undergoing gastrectomy： a randomized double-blinded controlled trial. J Invest Surg. 2019：1-10.
31.Wong CS, Aly EH. The effects of enteral immunonutrition in upper gastrointestinal surgery： a systematic review and meta-analysis. Int J Surg. 2016；29：137-150.
32.Achilli P, Mazzola M, Bertoglio CL, et al. Preoperative immunonutrition in frail patients with colorectal cancer： an intervention to improve postoperative outcomes. Int J Colorectal Dis. 2020；35(1)：19-27.
33.Sultan J, Griffin SM, Di Franco F, et al. Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery. Br J Surg. 2012；99(3)：346-355.
34.Claudino MM, Lopes JR, Rodrigues VD, et al. Postoperative complication rate and survival of patients with gastric cancer undergoing immunonutrition： a retrospective study. Nutrition. 2019；70：110590.
35.Suchner U, Heyland DK, Peter K. Immune-modulatory actions of arginine in the critically ill. Br J Nutr. 2002；87 Suppl 1：S121-S132.
36.Andrews FJ, Griffiths RD. Glutamine： essential for immune nutrition in the critically ill. Br J Nutr. 2002；87 Suppl 1：S3-S8.
37.Zhang S, Zeng X, Ren M, et al. Novel metabolic and physiological functions of branched chain amino acids： a review. J Anim Sci Biotechnol. 2017；8：10.
38.Calder PC. Dietary modification of inflammation with lipids. Proc Nutr Soc. 2002；61(3)：345-358.
39.Grimble GK, Westwood OM. Nucleotides as immunomodulators in clinical nutrition. Curr Opin Clin Nutr Metab Care. 2001；4(1)：57-64.
40.Zhang Q, Pan Y, Zeng B, et al. Intestinal lysozyme liberates Nod1 ligands from microbes to direct insulin trafficking in pancreatic beta cells. Cell Res. 2019；29(7)：516-532.
41.Bodogai M, OConnell J, Kim K, et al. Commensal bacteria contribute to insulin resistance in aging by activating innate B1a cells. Sci Transl Med. 2018；10(467).
42.Bunker JJ, Drees C, Watson AR, et al. B cell superantigens in the human intestinal microbiota. Sci Transl Med. 2019；11(507).
43.Elmer GW, McFarland LV. Biotherapeutic agents in the treatment of infectious diarrhea. Gastroenterology clinics of North America. 2001；30(3)：837-854.
44.Boleij A, Roelofs R, Danne C, et al. Selective antibody response to Streptococcus gallolyticus pilus proteins in colorectal cancer patients. Cancer Prev Res (Phila). 2012；5(2)：260-265.
45.Ponton F, Wilson K, Cotter SC, et al. Nutritional immunology： a multi-dimensional approach. PLoS Pathog. 2011；7(12)：e1002223.
46.Kohl KD, Stengel A, Dearing MD. Inoculation of tannin-degrading bacteria into novel hosts increases performance on tannin-rich diets. Environ Microbiol. 2016；18(6)：1720-1729.
47.Douglas AE. Nutritional interactions in insect-microbial symbioses： aphids and their symbiotic bacteria Buchnera. Annu Rev Entomol. 1998；43：17-37.
48.Matsuzaki T, Chin J. Modulating immune responses with probiotic bacteria. Immunol Cell Biol. 2000；78(1)：67-73.
49.MH F. Probiotics, Irritable bowel syndrome, and inflammatory bowel disease. Curr Treat Options Gastroenterol. 2003；6(4)：283-288.
50.Chandrasekharan B, Saeedi BJ, Alam A, et al. Interactions between commensal bacteria and enteric neurons, via FPR1 induction of ROS, increase gastrointestinal motility in mice. Gastroenterology. 2019；157(1)：179-192.e172.
51.Lee MC, Hsu YJ, Chuang HL, et al. In Vivo Ergogenic Properties of the Bifidobacterium longum OLP-01 Isolated from a Weightlifting Gold Medalist. Nutrients. 2019；11(9).
52.Zarate G, Gonzalez S, Chaia AP. Assessing survival of dairy propionibacteria in gastrointestinal conditions and adherence to intestinal epithelia. Methods Mol Biol. 2004；268：423-432.
53.Nomura T, Tsuchiya Y, Nashimoto A, et al. Probiotics reduce infectious complications after pancreaticoduodenectomy. Hepatogastroenterology. 2007；54(75)：661-663.
54.Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012；142(7)：1476-1482； quiz e1415-1476.
55.Sun JK, Li WQ, Ke L, et al. Early enteral nutrition prevents intra-abdominal hypertension and reduces the severity of severe acute pancreatitis compared with delayed enteral nutrition： a prospective pilot study. World J Surg. 2013；37(9)：2053-2060.