胃癌围手术期全程营养管理:筛查‑评估‑ 干预的整合路径

Whole-course nutritional management in perioperative period of gastric cancer: an integra-ted screening-assessment-intervention pathway

  • 摘要: 胃癌是全世界常见的消化系统恶性肿瘤,手术治疗是其目前主要治疗手段之一。营养风险和营养不良在胃癌患者中普遍存在,是胃癌预后的独立危险因素,严重影响患者手术治疗效果、生命质量和总生存期。针对伴有营养风险和营养不良的胃癌患者,实施基于筛查‑评估‑干预的围手术期全程营养管理是改善胃癌治疗效果的突破口。在营养风险筛查方面,基于营养风险筛查量表2002评分的营养风险筛查能够快速识别胃癌患者术前营养风险状态,为及时启动营养治疗提供关键依据;在营养评估和营养不良诊断方面,多维度的评估模式和统一规范的全球领导人营养不良倡议标准可以明确营养不良分层;在围手术期精准化营养治疗方面,全程营养管理契合加速康复外科理念,并显著改善胃癌患者的临床预后。笔者深入阐述胃癌营养风险筛查、营养评估和营养不良的诊断以及围手术期的精准化营养治疗,探讨胃癌围手术期全程营养管理路径,旨在预防并治疗胃癌患者围手术期营养不良,从而最大化营养治疗的临床获益。

     

    Abstract: Gastric cancer is one of the most common malignant tumors of the digestive system worldwide, with surgical treatment remaining the mainstay of therapy. Nutritional risk and malnutrition are highly prevalent among patients with gastric cancer, which are recognized as independent prognostic factors. These conditions significantly affect surgical outcomes, quality of life, and overall survival of patient. For gastric cancer patients with nutritional risk and malnutrition, the implementation of a perioperative, whole-course nutritional management strategy based on the "screening-assessment-intervention" framework represents a critical breakthrough to improve therapeutic outcomes. In terms of nutritional risk screening, the nutritional risk screening 2002 scoring system enables rapid identification of preoperative nutritional risk status in gastric cancer patients, thereby providing a timely basis for initiating nutritional therapy. For nutritional assessment and diagnosis of malnutrition, a multidimensional evaluation model combined with the standardized global leadership initiative on malnutrition criteria allows for accurate stratification of nutritional status. With regard to perioperative precision nutrition therapy, whole-course nutritional management aligns with the enhanced recovery after surgery concept and significantly improves the clinical prognosis of gastric cancer patients. The authors elaborate on nutritional risk screening, nutritional assessment, and diagnosis of malnutrition in gastric cancer, as well as perioperative precision nutri-tional therapy. They also explore the whole-course nutritional management pathway for gastric cancer patients during the perioperative period, aiming to prevent and treat perioperative malnutrition in these patients and thereby maximize the clinical benefits of nutritional therapy.

     

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