专家论坛

恶性肠梗阻营养通路的选择

  • 张勇胜 ,
  • 刘硒碲 ,
  • 陈俊强
展开
  • 1.广西医科大学第一附属医院临床营养科,南宁  530021;2.广西医科大学第一附属医院胃肠腺体外科,南宁 530021

网络出版日期: 2021-04-12

基金资助

广西壮族自治区卫生健康委自筹课题(Z20190487)

Selection of nutrition route in malignant bowel obstruction

  • Zhang Yongsheng ,
  • Liu Xidi ,
  • Chen Junqiang
Expand
  • 1.Department of Clinical Nutrition, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;2.Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China

Online published: 2021-04-12

摘要

恶性肠梗阻(MBO)是恶性肿瘤常见的并发症之一,特别在晚期肿瘤患者的发病率高,严重影响患者的营养摄入,导致营养不良的发生或加重,降低生活质量,缩短生存时间。恶性肿瘤因其在生长的过程中代谢旺盛,极易引起机体营养不良,当患者出现肠梗阻时,营养不良、恶液质的发生率和程度显著增加。营养不良已经成为MBO患者死亡的重要原因之一。MBO患者的营养治疗是MBO治疗的关键环节,及时有效的营养治疗能维持MBO患者的营养状态,改善营养不良,提高各种治疗的耐受性及有效性。而选择恰当的营养通路是成功实施营养治疗的基本保证,尤其对于营养不良和存在营养风险的MBO患者意义重大。对于MBO患者营养通路选择,目前仍存在不少争议。MBO患者的营养通路选择需根据患者梗阻部位、治疗方式、并发症风险及预计生存期等情况,权衡利弊后进行合理选择。本文主要对MBO患者各种常见的营养治疗通路进行总结,旨在为MBO患者选择安全、有效的营养通路提供参考依据。

本文引用格式

张勇胜 , 刘硒碲 , 陈俊强 . 恶性肠梗阻营养通路的选择[J]. 肿瘤代谢与营养电子杂志, 2020 , 7(3) : 272 -275 . DOI: 10.16689/j.cnki.cn11-9349/r.2020.03.005

Abstract

Malignant bowel obstruction (MBO) is one of the complications in tumor and have high rates in advanced tumors, which affected nutrients intake and leads to the occurrence or exacerbation of malnutrition. This may lower the quality of life and shorten the time of survival. Tumors metabolize vigorously during growth and it is highly susceptible to malnutrition, which may be significant increase and end with cachexia when the patient develop to intestinalobstruction. Malnutrition has become one of the leading causes of death in MBO patient. Nutritional therapy in MBO patients is the key in the treatment of MBO, timely and effective nutritional therapy can maintain the nutritional status and improve malnutrition, improve tolerance and effectiveness of various treatments. The selection of appropriate nutrition route is the basic guarantee for successful implementation of nutritional therapy, especially for patients with malnutrition and at nutritional risk. There is still controversy in nutrition route for MBO patients. We should choose individual nutrition route on the basis of the obstructive site, treatment, complication risks and estimated survival, et al. We summarizes the various common nutrition route in MBO patients, aiming to provide safe and effective nutrition route clinically.

参考文献

1.于世英, 王杰军, 王金万, 等. 晚期癌症患者合并肠梗阻治疗的专家共识[J]. 中华肿瘤杂志, 2007,  29(8):637-640.
2.TUCA A, GUELL E, MARTINEZ-LOSADA E, et al. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution[J]. Cancer Manag Res, 2012,  4:159-169.
3.PASANISI F, ORBAN A, SCALFI L, et al. Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition[J]. Nutrition, 2001,  17(7/8):581-584.
4.HSU K, PROMMER E, MURPHY M C, et al. Pharmacologic management of malignant bowel obstruction: when surgery Is not an option[J]. J Hosp Med, 2019,  14(6):367-373.
5.BOZZETTI F. The role of parenteral nutrition in patients with malignant bowel obstruction[J]. Support Care Cancer, 2019,  27(12):4393-4399.
6.PAUL OLSON T J, PINKERTON C, BRASEL K J, et al. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review[J]. JAMA Surg, 2014,  149(4):383-392.
7.SCOLAPIO J S, PICCO M F, TARROSA V B. Enteral versus parenteral nutrition: the patients preference[J]. JPEN J Parenter Enteral Nutr, 2002,  26(4):248-250.
8.ARENDS J, BACHMANN P, BARACOS V, et al. ESPEN guidelines on nutrition in cancer patients[J]. Clin Nutr, 2017,  36(1):11-48.
9.吴国豪, 谈善军. 成人家庭肠外营养中国专家共识[J]. 中国实用外科杂志, 2017,  37(4):406-411.
10.NAGHIBI M, SMITH T R, ELIA M. A systematic review with meta-analysis of survival, quality of life and cost-effectiveness of home parenteral nutrition in patients with inoperable malignant bowel obstruction[J]. Clin Nutr, 2015,  34(5):825-837.
11.PORZIO G, AIELLI F, VERNA L, et al. Can malignant bowel obstruction in advanced cancer patients be treated at home?[J]. Support Care Cancer, 2011,  19(3):431-433.
12.ANTHONY T, BARON T, MERCADANTE S, et al. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction[J]. J Pain Symptom Manage, 2007,  34(1 Suppl):S49-S59.
13.LAVAL G, MARCELIN-BENAZECH B, GUIRIMAND F, et al. Recommendations for bowel obstruction with peritoneal carcinomatosis[J]. J Pain Symptom Manage, 2014,  48(1):75-91.
14.MARTINEZ CASTRO P, VARGAS L, MANCHEO A, et al. Malignant bowel obstruction in relapsed ovarian cancer with peritoneal carcinomatosis: an occlusive state[J]. Int J Gynecol Cancer, 2017,  27(7):1367-1372.
15.SOWERBUTTS A M, LAL S, SREMANAKOVA J, et al. Home parenteral nutrition for people with inoperable malignant bowel obstruction[J]. Cochrane Database Syst Rev, 2018,  8(8):Cd012812.
16.FAN B G. Parenteral nutrition prolongs the survival of patients associated with malignant gastrointestinal obstruction[J]. JPEN J Parenter Enteral Nutr, 2007,  31(6):508-510.
17.Bozzetti F, Cozzaglio L, Biganzoli E, et al. Quality of life and length of survival in advanced cancer patients on home parenteral nutrition[J]. Clin Nutr, 2002,  21(4):281-288.
18.SANTARPIA L, ALFONSI L, PASANISI F, et al. Predictive factors of survival in patients with peritoneal carcinomatosis on home parenteral nutrition[J]. Nutrition, 2006,  22(4):355-360.
19.FRANKE A J, IQBAL A, STARR J S, et al. Management of malignant bowel obstruction associated with GI cancers[J]. J Oncol Pract, 2017,  13(7):426-434.
20.KOCK H J, PIETSCH M, KRAUSE U, et al. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems[J]. World J Surg, 1998,  22(1):12-16.
21.VELIOG∨LU Y, YKSEL A, SNMAZ E. Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein[J]. Turk Gogus Kalp Damar Cerrahisi Derg, 2019,  27(4):499-507.
22.刘明, 石汉平. 中国恶性肿瘤营养治疗通路专家共识[M]. 北京: 人民卫生出版社, 2018.
23.陈洪生, 吕强, 王雷, 等. 中国恶性肿瘤营养治疗通路专家共识解读:输液港[J]. 肿瘤代谢与营养电子杂志, 2018,  5(3):251-256.
24.樊跃平, 张田, 曲芊诺, 等. 中国恶性肿瘤营养治疗通路专家共识解读——经外周静脉置管部分[J]. 肿瘤代谢与营养电子杂志, 2019,  6(3):301-304.
25.CHEN J H, HUANG T C, CHANG P Y, et al. Malignant bowel obstruction: A retrospective clinical analysis[J]. Mol Clin Oncol, 2014,  2(1):13-18.
26.江波. 以肠道功能保护与恢复为核心的恶性肠梗阻多学科综合治疗决策[J]. 实用临床医药杂志, 2019,  23(23):1-4+23.
27.石汉平, 陈永兵, 饶本强, 等. 恶性肠梗阻的整合治疗[J]. 肿瘤代谢与营养电子杂志, 2019,  6(4):421-426.
28.马骏, 霍介格. 恶性肠梗阻的治疗现状与进展[J]. 世界华人消化杂志, 2017,  25(21):1921-1927.
29.LI D, DU H, SHAO G, et al. Application of small intestine decompression combined with oral feeding in middle and late period of malignant small bowel obstruction[J]. Oncol Lett, 2017,  14(1):180-184.30.DITTRICH A, SCHUBERT B, KRAMER M, et al. Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction[J]. Support Care Cancer, 2017,  25(9):2849-2856.
31.ZUCCHI E, FORNASARIG M, MARTELLA L, et al. Decompressive percutaneous endoscopic gastrostomy in advanced cancer patients with small-bowel obstruction is feasible and effective: a large prospective study[J]. Support Care Cancer, 2016,  24(7):2877-2882.
32.KAWATA N, KAKUSHIMA N, TANAKA M, et al. Percutaneous endoscopic gastrostomy for decompression of malignant bowel obstruction[J]. Dig Endosc, 2014,  26(2):208-213.
33.UDOMSAWAENGSUP S, BRETHAUER S, KROH M, et al. Percutaneous transesophageal gastrostomy (PTEG):a safe and effective technique for gastrointestinal decompression in malignant obstruction and massive ascites[J]. Surg Endosc, 2008,  22(10):2314-2318.
34.BROOKSBANK M A, GAME P A, ASHBY M A. Palliative venting gastrostomy in malignant intestinal obstruction[J]. Palliat Med, 2002,  16(6):520-526.
35.POTHURI B, MONTEMARANO M, GERARDI M, et al. Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma[J]. Gynecol Oncol, 2005,  96(2):330-334.
36.CANNIZZARO R, BORTOLUZZI F, VALENTINI M, et al. Percutaneous endoscopic gastrostomy as a decompressive technique in bowel obstruction due to abdominal carcinomatosis[J]. Endoscopy, 1995,  27(4):317-320.
37.SELBY D, NOLEN A, SITTAMBALAM C, et al. Percutaneous Transesophageal Gastrostomy (PTEG):a safe and well-tolerated procedure for palliation of end-stage malignant bowel obstruction[J]. J Pain Symptom Manage, 2019,  58(2):306-310.
38.RATH K S, LOSETH D, MUSCARELLA P, et al. Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer[J]. Gynecol Oncol, 2013,  129(1):103-106.
39.杨志勇, 魏晶晶, 庄则豪. 中国恶性肿瘤营养治疗通路专家共识解读:非外科空肠造口[J]. 肿瘤代谢与营养电子杂志, 2018,  5(2):139-143.
40.SHIKE M, SCHROY P, RITCHIE M A, et al. Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection[J]. Gastrointest Endosc, 1987, 33(5):372-374.
41.杨柳, 张金坤. 肠道金属支架对恶性肠梗阻的疗效分析[J]. 中国现代医药杂志, 2020,  22(3):58-60.
42.CAO Y, DENG S, GU J, et al. Clinical effectiveness of endoscopic stent placement in treatment of acute intestinal obstruction caused by colorectal cancer[J]. Med Sci Monit, 2019,  25:5350-5355.
43.GRBULAK B, GRBULAK E K, AKGN  E, et al. Endoscopic stent placement in the management of malignant colonic obstruction: Experiences from two centers[J]. Ulus Cerrahi Derg, 2015,  31(3):132-137.
44.YOUNG C J, DE-LOYDE K J, YOUNG J M, et al. Improving quality of life for people with incurable large-bowel obstruction: randomized control trial of colonic stent insertion[J]. Dis Colon Rectum, 2015,  58(9):838-849.
文章导航

/