Frountzas Maximos, Stefanoudakis Dimitrios, Mela Evgenia, Theodorou Panagiotis, Theodoropoulos George E, Theodorou Dimitrios, Toutouzas Konstantinos G
First Propaedeutic Department of Surgery, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Medicina (Kaunas). 2025 Aug 14;61(8):1459. doi: 10.3390/medicina61081459.
Major surgical operations of the gastrointestinal tract, such as colorectal resections, lead to significant burden on the human body, which is expressed during the first postoperative hours with an intense inflammatory reaction and consumption of a large amount of energy, increasing patients' nutritional requirements. Therefore, specific protocols have been implemented for the early initiation of oral feeding. However, not every patient could meet them due to old age and associated pathophysiological changes, the use of opioid drugs for the management of postoperative pain (which is associated with postoperative ileus or nausea), as well as open resections which might lead to gastrointestinal impairment during the first postoperative days. Therefore, a tailored nutritional approach after colorectal resections seems necessary under specific conditions. Parenteral nutrition could be part of this personalized treatment, as it might counterbalance the energy deficit occurring during the early postoperative period, which appears to be associated with adverse clinical outcomes. Nevertheless, the conventional way of administration through central venous lines is associated with significant complications. On the other hand, the alternative administration of parenteral nutrition through a peripheral venous catheter could avoid morbidity, maintaining patients' energy balance even during the first postoperative hours. However, the efficacy of peripheral parenteral nutrition on the postoperative outcomes of patients undergoing colorectal resections needs to be investigated in prospective randomized trials. The aim of the present review is to present the current trends regarding administration of peripheral parenteral nutrition (PPN) after colorectal resections and highlight any potential correlations between PPN and postoperative inflammatory reaction, as well as short-term nutritional status.
胃肠道的大型外科手术，如结直肠切除术，会给人体带来巨大负担，这在术后最初几个小时表现为强烈的炎症反应和大量能量消耗，从而增加患者的营养需求。因此，已实施了早期开始经口喂养的特定方案。然而，由于年龄较大和相关的病理生理变化、使用阿片类药物控制术后疼痛（这与术后肠梗阻或恶心有关）以及开放性切除术可能在术后最初几天导致胃肠道功能受损，并非每个患者都能满足这些方案。因此，在特定情况下，结直肠切除术后采用个性化的营养方法似乎是必要的。肠外营养可能是这种个性化治疗的一部分，因为它可能抵消术后早期出现的能量不足，而这种能量不足似乎与不良临床结果相关。然而，通过中心静脉置管的传统给药方式会引发严重并发症。另一方面，通过外周静脉导管进行肠外营养的替代给药方式可以避免发病，即使在术后最初几个小时也能维持患者的能量平衡。然而，外周肠外营养对结直肠切除患者术后结局的疗效需要在前瞻性随机试验中进行研究。本综述的目的是介绍结直肠切除术后外周肠外营养（PPN）给药的当前趋势，并突出PPN与术后炎症反应以及短期营养状况之间的任何潜在关联。
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