Wu Ming-Hsun, Lin Ming-Tsan, Chen Wei-Jao
Department of Surgery and Traumatology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
Hepatogastroenterology. 2008 Mar-Apr;55(82-83):799-802.
BACKGROUND/AIMS: Malnutrition is frequently seen in gastric cancer patients. Perioperative nutritional support may reduce postoperative complications, especially in severely depleted gastric cancer patients with GI obstruction. However, the beneficial effects of perioperative total parenteral nutrition for gastric cancer surgery patients still have not been clearly demonstrated in Taiwan. This study evaluated the effects of perioperative nutritional support for severely malnourished patients with gastric cancer undergoing gastrectomy.
The study analyzed malnourished patients with gastric cancer who underwent gastrectomy from Oct 2000 to Oct 2002. Total nutritional support was examined for severely depleted patients with body weight loss > 10% over 6 months or a low serum albumin level (< 3.0g/dL). These patients were classified into two groups, those without TPN (total parenteral nutrition) use and those with TPN use. The patients who received TPN were further divided into 2 groups, those who received TPN postoperatively and those who received it perioperatively. Correlation with the postoperative outcome was then made.
Forty patients who underwent total gastrectomy and 78 patients who underwent subtotal gastrectomy had severe malnutrition preoperatively. We found gastric cancer patients with malnutrition had high morbidity and mortality rates (29.7% and 8.6%, respectively) when undergoing gastrectomy, especially total gastrectomy. There was a higher morbidity rate in the group without TPN (66.7% vs. 16% and 43.75% vs. 21.74%) in both the subtotal and total gastrectomy groups, and a longer postoperative stay for patients without TPN (35.21 +/- 25.05 vs. 21.32 +/- 12.32) in the total gastrectomy group than for patients with TPN in these groups. The mortality rate, morbidity rate and postoperative stay were higher in patients who received postoperative TPN only than in patients with peri-operative TPN.
TPN use, perioperatively or postoperatively, can help reduce the morbidity and mortality of these patients. Total nutritional support is effective for patients with malnutrition undergoing gastric cancer surgery.
背景/目的：营养不良在胃癌患者中很常见。围手术期营养支持可减少术后并发症，尤其是在伴有胃肠道梗阻的严重营养不良的胃癌患者中。然而，围手术期全胃肠外营养对台湾胃癌手术患者的有益效果仍未得到明确证实。本研究评估了围手术期营养支持对接受胃切除术的严重营养不良胃癌患者的影响。
本研究分析了2000年10月至2002年10月期间接受胃切除术的营养不良胃癌患者。对体重在6个月内下降超过10%或血清白蛋白水平低（<3.0g/dL）的严重营养不良患者进行全面营养支持检查。这些患者被分为两组，即未使用全胃肠外营养（TPN）的患者和使用TPN的患者。接受TPN的患者进一步分为两组，即术后接受TPN的患者和围手术期接受TPN的患者。然后分析其与术后结果的相关性。
40例行全胃切除术和78例行胃次全切除术的患者术前存在严重营养不良。我们发现营养不良的胃癌患者在接受胃切除术（尤其是全胃切除术）时发病率和死亡率较高（分别为29.7%和8.6%）。在胃次全切除术和全胃切除术组中，未使用TPN的组发病率更高（分别为66.7%对16%和43.75%对21.74%），并且在全胃切除术组中，未使用TPN的患者术后住院时间比使用TPN的患者更长（35.21±25.05对21.32±12.32）。仅术后接受TPN的患者的死亡率、发病率和术后住院时间高于围手术期接受TPN的患者。
围手术期或术后使用TPN有助于降低这些患者的发病率和死亡率。全面营养支持对接受胃癌手术的营养不良患者有效。
