1例肠内营养改善超高龄食管癌患者生活质量病例报道

杜嘉慧; 王宇; 李宗伟; 刘思涵; 杨文影; 朱婷

doi:10.16766/j.cnki.issn.1674-4152.004318

1例肠内营养改善超高龄食管癌患者生活质量病例报道

doi: 10.16766/j.cnki.issn.1674-4152.004318

杜嘉慧^{1, 2},
王宇²,
李宗伟³,
刘思涵²,
杨文影²,
朱婷^2, ,

1.
蚌埠医科大学研究生院，安徽蚌埠 233030
2.
合肥市第一人民医院肿瘤科, 安徽合肥 230031
3.
安徽医科大学生命科学学院, 安徽合肥 230032

详细信息

通讯作者:
朱婷，E-mail：ting9977@126.com

中图分类号: R735.1 R459.3
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- 文章访问数: 10
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- 被引次数: 0
出版历程
- 收稿日期: 2025-04-11
- 网络出版日期: 2026-03-13

A case report of enteral nutrition improving the quality of life of ultra-elderly patients with esophageal cancer

DU Jiahui^{1, 2},
WANG Yu²,
LI Zongwei³,
LIU Sihan²,
YANG Wenying²,
ZHU Ting^{2
, ,}

1.
Graduate School of Bengbu Medical University, Bengbu, Anhui 233030, China

摘要

摘要: 进行性吞咽困难是食管癌患者的常见症状，食管癌是营养不良发生风险最高的恶性肿瘤。对此，临床医生往往选用肠内营养来维持患者营养状态。本文以我院肿瘤科发现1例超高龄食管癌患者为典型，通过复习2014—2024年中英文文献报道的食管癌肠内营养支持病例，探索减轻患者肠内营养导致的不良反应及并发症的策略，为食管癌患者实现最佳营养支持。对于食管癌患者，应首先进行全面的营养筛查和评估，制定个体化的营养治疗方案。
- 食管癌 /
- 肠内营养 /
- 不良反应 /
- 营养筛查
Abstract: Progressive dysphagia is a common symptom in patients with esophageal cancer, which is the malignancy with the highest risk of developing malnutrition. In this regard, clinicians often use enteral nutrition to maintain the nutritional status of patients. Based on the case of ultra-elderly esophageal cancer found in the Department of Oncology of our hospital, this article reviews the enteral nutrition support cases of esophageal cancer reported in Chinese and English literature from 2014 to 2024, explores strategies to alleviate the adverse reactions and complications caused by enteral nutrition in patients, and achieves optimal nutritional support for esophageal cancer patients. For patients with esophageal cancer, a comprehensive nutritional screening and evaluation should be performed first, and an individualized nutritional therapy plan should be developed.
- Enteral nutrition /
- Esophageal cancer /
- Aadverse effects /
- Nutritional screening

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图 1 1例食道癌患者2023年5月25日上消化道造影图像

注：上消化道造影图像提示食管下段狭窄，考虑食管癌。

Figure 1. An image of upper gastrointestinal tract obtained from a patient with esophageal cancer on May 25, 2023

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表 1 患者治疗期间实验室检查结果

Table 1. Laboratory findings during the patient' s treatment

日期	白细胞(10⁹/L)	血红蛋白(g/L)	血小板(10⁹/L)	白蛋白(g/L)	胆固醇(mmol/L)	葡萄糖(mmol/L)	血钾(mmol/L)
2023年5月23日	4.77	101	225	32.0	3.96	4.93	3.59
2023年6月7日	5.59	88	240	37.5		3.48	4.51
2023年7月5日	4.71	105	220	38.0	2.95	4.28	4.46
2023年8月10日	3.11	119	176	30.6		4.85	4.37

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表 2 食管癌肠内营养管理部分指南推荐

Table 2. Guidelines for the management of enteral nutrition in esophageal cancer

指南名称	推荐意见	推荐等级
2021年美国胃肠病学会关于恶性消化道梗阻最佳管理的临床实践更新：专家审查^[5]	对于因食管癌而出现食管梗阻且可能适合切除且担心营养不良的患者，临床医生可以考虑使用肠内饲管(通过鼻胃管或经皮途径)	A
2022年发布《ESPEN实用指南：家庭肠内营养》^[6]	肠内营养适用于营养风险高或营养不良、无法通过口服途径满足营养需求以及表现出功能性胃肠道的患者。患者1周不能进食或能量摄入在1~2周内低于预估需求的60%[通常低于10 kcal/(kg·d)或缺乏600~800 kcal/d]，则认为营养不足，肠内营养应在1周内开始。	A
2023年发布的口咽部吞咽困难的临床实践指南^[7]	建议营养干预以改善口咽吞咽困难患者的摄入或营养状况。早期肠内管饲在口咽吞咽困难患者的临床病程或生存率方面显示出总体改善。	A
2023年发布的成人患者经鼻胃管喂养临床实践指南^[8]	无法经口进食的营养不良或有潜在营养风险的食管癌患者早期予以鼻饲喂养	A
2024年《ESPEN实用指南：多病内科住院患者的营养支持》^[9]	在口服不能满足营养需求的多病内科住院患者中，肠内营养的使用优于肠外营养，因为肠内营养的感染性、非感染性并发症风险较低，并能维持肠道完整性。对于口服不能满足营养需求的多病内科住院患者，可在肠外营养前给予肠内营养，以确保达到营养目标。	A

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参考文献(20)

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