Sohda Makoto, Kuwano Hiroyuki
Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
Kyobu Geka. 2017 Jul;70(8):708-711.
Esophagectomy is a most invasive operation, as compared with other operations of the gastrointestinal tract. Obstructions of the food passageway and the overgrowth of tissue postoperatively may lead to malnutrition. Therefore, significant assessment and management of nutrients is very important for esophageal cancer patients. The body mass index, albumin, the prognostic nutritional index, controlling nutritional status, and the Glasgow Prognostic Score are reported as useful assessment tools for esophageal cancer. The patient's general condition, including his or her nutritional status, influences the performance of esophagectomy. Therefore, improving the nutritional status enables an adaptation of therapy and leads to preventive benefits for decreasing postoperative complications. The previously cited nutritional tools are very useful indices because the measurement of each factor is convenient and fast. Also, early recovery from operative stress is the most important target of postoperative management after esophagectomy. Accurate and adequate perioperative management allows early recovery from operative stress in esophageal cancer patients. Preoperative steroid injection, oral care, respiratory training and rehabilitation, smoking cessation, and so on are very important for esophageal cancer patients. The efforts of a team that includes doctors, nurses, and healthcare providers are necessary for sufficient postoperative management after esophagectomy.
与胃肠道的其他手术相比,食管切除术是一种侵入性很强的手术。食物通道梗阻和术后组织过度生长可能导致营养不良。因此,对食管癌患者进行重要的营养评估和管理非常重要。据报道,体重指数、白蛋白、预后营养指数、控制营养状况和格拉斯哥预后评分是食管癌有用的评估工具。患者的一般状况,包括营养状况,会影响食管切除术的实施。因此,改善营养状况有助于调整治疗方案,并对减少术后并发症有预防作用。前面提到的营养工具是非常有用的指标,因为每个因素的测量都方便快捷。此外,从手术应激中早期恢复是食管切除术后术后管理的最重要目标。准确和充分的围手术期管理可使食管癌患者从手术应激中早期恢复。术前注射类固醇、口腔护理、呼吸训练与康复、戒烟等对食管癌患者非常重要。食管癌切除术后充分的术后管理需要医生、护士和医护人员组成的团队共同努力。