Carbone M, Gandolfo S, Carbonero C, Manno E
Istituto di Clinica Odontostomatologica, Università degli Studi di Torino.
Minerva Stomatol. 1994 May;43(5):239-46.
The authors review the literature on problems of nutrition in patients with operable maxillofacial neoplasms. The causes of malnutrition in head-neck tumours will be particularly examined: metabolic alteration due to the presence of neoplasm; the tumour being situated in the first upper respiratory-digestive tracts; the side effects of chemotherapy and/or radiotherapy; the results of surgery and finally those of a late diagnosis. Once clinical nutrition has been indicated by both clinical and biochemical parameters, a plan for the most frequently used pre- postoperative treatments is drawn up. Reviewing the literature disagreement is found as the most effective method--enteral or parenteral--given that both solutions present advantages and disadvantages. The former is more physiological less expensive and simpler to carry out while the latter permits a more individualised form of treatment and the metabolic evaluation is simplified. The authors will go to present their own treatment plans: parenteral in the preoperative phase and in the postoperative patient a gradual weaning from parenteral to enteral treatment. The most important lines in both enteral and parenteral feeding are examined and the authors conclude by confirming that artificial nutritional therapy makes absolutely no difference to the prognosis but allows the patient to undergo the appropriate therapy.
作者回顾了有关可手术治疗的颌面部肿瘤患者营养问题的文献。将特别研究头颈肿瘤患者营养不良的原因：肿瘤存在导致的代谢改变；肿瘤位于上呼吸道和消化道的起始部位；化疗和/或放疗的副作用；手术结果以及最终的诊断延迟结果。一旦临床和生化参数表明需要进行临床营养支持，就会制定最常用的术前治疗方案。回顾文献发现，对于最有效的方法——肠内营养或肠外营养——存在分歧，因为两种方法都有优缺点。前者更符合生理需求、成本更低且实施更简单，而后者允许采用更个体化的治疗方式，并且简化了代谢评估。作者将介绍他们自己的治疗方案：术前采用肠外营养，术后患者从肠外营养逐渐过渡到肠内营养。研究了肠内营养和肠外营养的最重要原则，作者最后确认人工营养治疗对预后绝对没有影响，但能让患者接受适当的治疗。
