回肠造口联合营养支持治疗慢性放射性肠损伤
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摘要
目的:总结回肠造口联合营养支持在治疗慢性放射性肠损伤中的应用。方法:回顾分析2012年1月至2016年12月在南京军区南京总医院普通外科接受一期回肠造口术联合围手术期营养支持的慢性放射性肠损伤病人的病历资料,观察短期并发症、围手术期营养过程,随访其远期预后。结果:46例慢性放射性肠损伤病人纳入研究,术后并发症发生率为36.96%,所有病人出院时均恢复全肠内营养支持,时间为(18±15)d,无病人死亡。随访率78.26%,随访时间(25±17)个月。随访期间肿瘤复发7例(19.44%),死亡6例(16.67%)。除死亡病人外其余30例病人(83.33%)均维持全肠内喂养,其中27例病人(75%)恢复正常饮食。21例(58.33%)后于我院行造口还纳手术,术后恢复良好。结论:对选择的放射性肠损伤病人,回肠造口联合围手术期营养支持可以有效恢复肠道通畅性和全肠内营养,可以有效降低病人死亡率。
Objective: To review the application of ileostomy combined with perioperative nutrition support therapy in the treatment of chronic radiation intestinal injury.Methods: The clinical data of patients with chronic radiation intestinal injury who received ileostomy combined with perioperative nutrition support therapy in the department of general surgery, Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2016 were retrospectively analyzed. The short-term complications and perioperative nutrition process were recorded, and the longterm prognoses were followed up.Results: Forty-six patients were included in the study. The overall postoperative complication rate was 36.96%. All the patients restored total enteral nutrition at the time of discharge(18±15) days. There was no post-operative mortality. Thirty-six patients were followed up(follow-up rate of 78.26%), and the followup time was(25 ± 17) months. Tumor recurrence was occurred in 7 patients(19.44%) during follow-up and 6 deaths(16.67%). All of the 30(83.33%) survived patients maintained total enteral feeding, 27 of whom(75%) returned to normal diet. Twenty-one patients(58.33%) underwent a second staging ostomy surgery in our hospital and recovered well. Conclusion: For selected patients with chronic radiation intestinal injury, ileostomy combined with perioperative nutrition support therapy could effectively restore intestinal patency and total enteral nutrition, and reduce the mortality.
Objective: To review the application of ileostomy combined with perioperative nutrition support therapy in the treatment of chronic radiation intestinal injury.Methods: The clinical data of patients with chronic radiation intestinal injury who received ileostomy combined with perioperative nutrition support therapy in the department of general surgery, Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2016 were retrospectively analyzed. The short-term complications and perioperative nutrition process were recorded, and the longterm prognoses were followed up.Results: Forty-six patients were included in the study. The overall postoperative complication rate was 36.96%. All the patients restored total enteral nutrition at the time of discharge(18±15) days. There was no post-operative mortality. Thirty-six patients were followed up(follow-up rate of 78.26%), and the followup time was(25 ± 17) months. Tumor recurrence was occurred in 7 patients(19.44%) during follow-up and 6 deaths(16.67%). All of the 30(83.33%) survived patients maintained total enteral feeding, 27 of whom(75%) returned to normal diet. Twenty-one patients(58.33%) underwent a second staging ostomy surgery in our hospital and recovered well. Conclusion: For selected patients with chronic radiation intestinal injury, ileostomy combined with perioperative nutrition support therapy could effectively restore intestinal patency and total enteral nutrition, and reduce the mortality.
引文
[1]Onodera H,Nagayama S,Mori A,et al.Reappraisal of surgical treatment for radiation enteritis.World J Surg,2005,29(4):459-463.
[2]Wang J,Yao D,Zhang S,et al.Laparoscopic syugery for radiation enteritis.J Surg Res,2015,194(2):415-419.
[3]王剑,李幼生,毛琦,等.腹腔镜手术治疗盆腔放疗相关性肠损伤.中华外科杂志,2014,52(8):637-638.
[4]李宁.放射性肠炎的病程和外科治疗.中国实用外科杂志,2004,24(7):385-389.
[5]Zhu W,Gong J,Li Y,et al.A retrospective study of surgical treatment of chronic radiation enteritis.J Surg Oncol,2012,105(7):632-636.
[6]Shiraishi M,Hiroyasu S,Ishimine T,et al.Radiation enter ocolitis:overview of past 15 years.World J Surg,1998,22(5):491-493.
[7]李幼生,黎介寿.慢性放射性肠损伤的外科治疗进展.中国医师进修杂志,2007,30(5):1-5.
[8]Kalaiselvan R,Theis VS,Dibb M,et al.Radiation enteritis leading to intestinal failure:1994 patient-years of experience in a national referral centre.Eur J Clin Nutr,2014,68(2):166-170.
[9]黎介寿.腹部损伤控制性手术.中国实用外科杂志,2006,26(8):561-562.
[10]Scolapio JS,Ukleja A,Burnes JU,et al.Outcome of patients with radiation enteritis treated with home parenteral nutrition.Am JGastroenterol,2002,97(3):662-666.
[11]Cosnes J,Gendre JP,Le Quintrec Y.Chronic radiation enteritis II.General consequences and prognostic factors.Gastroenterol Clin Biol,1983,7(8-9):671-676.
[12]Van Stijn MF,Korkic-Halilovic I,Bakker MS,et al.Preoperative nutrition status and postoperative outcome in elderly general surgery patients:a systematic review.JPEN J Parenter Enteral Nutr,2013,37(1):37-43.
[13]Hennessey DB,Burke JP,Ni-Dhonochu T,et al.Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery:a multi-institutional study.Ann Surg,2010,252(2):325-329.
[14]Galland RB,Spencer J.The natural history of clinically established radiation enteritis.Lancet,1985,1(8440):1257-1258.
[15]Smith DH,DeCosse JJ.Radiation damage to the small intestine.World J Surg,1986,10(2):189-194.
[16]Regimbeau JM,Panis Y,Gouzi JL,et al.Operative and long term results after surgery for chronic radiation enteritis.Am J surgery,2001,182(3):237-242.
[17]李宁.外科新理念:损伤控制性手术.中国实用外科杂志,2007,27(1):28-32.
[18]Thompson JS.Short Bowel Syndrome and MalabsorptionCauses and Prevention.Viszeralmedizin,2014,30(3):174-178.
[19]Kong W,Wang J,Ni X,et al.Transition of Decade in Short Bowel Syndrome in China:Yesterday,Today,and Tomorrow.Transplant Proc,2015,47(6):1983-1987.
[20]Girvent M,Carlson GL,Anderson I,et al.Intestinal failure after surgery for complicated radiation enteritis.Ann R Coll Surg Engl,2000,82(3):198-201.
[21]Thompson JS,Weseman R,Rochling F,et al.Radiation therapy increases the risk of hepatobiliary complications in short bowel syndrome.Nutr Clin Pract,2011,26(4):474-478.
[2]Wang J,Yao D,Zhang S,et al.Laparoscopic syugery for radiation enteritis.J Surg Res,2015,194(2):415-419.
[3]王剑,李幼生,毛琦,等.腹腔镜手术治疗盆腔放疗相关性肠损伤.中华外科杂志,2014,52(8):637-638.
[4]李宁.放射性肠炎的病程和外科治疗.中国实用外科杂志,2004,24(7):385-389.
[5]Zhu W,Gong J,Li Y,et al.A retrospective study of surgical treatment of chronic radiation enteritis.J Surg Oncol,2012,105(7):632-636.
[6]Shiraishi M,Hiroyasu S,Ishimine T,et al.Radiation enter ocolitis:overview of past 15 years.World J Surg,1998,22(5):491-493.
[7]李幼生,黎介寿.慢性放射性肠损伤的外科治疗进展.中国医师进修杂志,2007,30(5):1-5.
[8]Kalaiselvan R,Theis VS,Dibb M,et al.Radiation enteritis leading to intestinal failure:1994 patient-years of experience in a national referral centre.Eur J Clin Nutr,2014,68(2):166-170.
[9]黎介寿.腹部损伤控制性手术.中国实用外科杂志,2006,26(8):561-562.
[10]Scolapio JS,Ukleja A,Burnes JU,et al.Outcome of patients with radiation enteritis treated with home parenteral nutrition.Am JGastroenterol,2002,97(3):662-666.
[11]Cosnes J,Gendre JP,Le Quintrec Y.Chronic radiation enteritis II.General consequences and prognostic factors.Gastroenterol Clin Biol,1983,7(8-9):671-676.
[12]Van Stijn MF,Korkic-Halilovic I,Bakker MS,et al.Preoperative nutrition status and postoperative outcome in elderly general surgery patients:a systematic review.JPEN J Parenter Enteral Nutr,2013,37(1):37-43.
[13]Hennessey DB,Burke JP,Ni-Dhonochu T,et al.Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery:a multi-institutional study.Ann Surg,2010,252(2):325-329.
[14]Galland RB,Spencer J.The natural history of clinically established radiation enteritis.Lancet,1985,1(8440):1257-1258.
[15]Smith DH,DeCosse JJ.Radiation damage to the small intestine.World J Surg,1986,10(2):189-194.
[16]Regimbeau JM,Panis Y,Gouzi JL,et al.Operative and long term results after surgery for chronic radiation enteritis.Am J surgery,2001,182(3):237-242.
[17]李宁.外科新理念:损伤控制性手术.中国实用外科杂志,2007,27(1):28-32.
[18]Thompson JS.Short Bowel Syndrome and MalabsorptionCauses and Prevention.Viszeralmedizin,2014,30(3):174-178.
[19]Kong W,Wang J,Ni X,et al.Transition of Decade in Short Bowel Syndrome in China:Yesterday,Today,and Tomorrow.Transplant Proc,2015,47(6):1983-1987.
[20]Girvent M,Carlson GL,Anderson I,et al.Intestinal failure after surgery for complicated radiation enteritis.Ann R Coll Surg Engl,2000,82(3):198-201.
[21]Thompson JS,Weseman R,Rochling F,et al.Radiation therapy increases the risk of hepatobiliary complications in short bowel syndrome.Nutr Clin Pract,2011,26(4):474-478.