0引言 据中国国家癌症中心发布的数据,2022年全国原发性肝癌发病人数36.77万,占全球病例的42.5％,位列各种癌症新发患者数第4位、发病率位列第5位;2022年因原发性肝癌死亡人数31.65万,死亡人数和病死率均位列第2位;人群肝癌5年相对生存率为14.4％,诊断时为中期和晚期比例达50％以上[1-3].
Robot surgery is an important trend in contemporary colorectal cancer surgical treatment. The Robotic Surgery Group, Colorectal Cancer Committee of Chinese Medical Doctor Association organized experts in relevant fields across the country to update and revise the application standards of robotic colorectal cancer surgery based on the Expert consensus on robotic surgery for colorectal cancer (2015 edition) and the revised version in 2020, in accordance with the development of robotic surgery concepts, technologies, and equipment in recent years, in order to promote the application and promotion of robotic surgery.
Objective To assess the impact of preoperative nutritional prehabilitation with total parenteral nutrition(TPN)versus enteral combined parenteral nutrition(EN+PN)on the outcomes of surgical patients with Crohn's disease(CD)complicated with intestinal obstruction or intestinal fistula.Methods The clinical data of 200 patients who underwent surgery after nutritional prehabilitation with TPN or EN+PN for CD combined with intestinal obstruction or intestinal fistula at the Inflammatory Bowel Disease Treatment Centre of General Surgery Department,Affiliated Hospital of Medical School,Nanjing University,from 2012-12-01 to 2021-12-01 were retrospectively analyzed.The patients were divided into the TPN group(137 cases)and,the EN+PN group(63 cases)according to the different ways of nutritional prehabilitation used.The propensity score matching(PSM)method was used to compare the effects of nutritional treatment and the incidence of complications at 30 d postoperatively between the TPN group and the EN+PN group.Results Before PSM,patients in the TPN and EN+PN groups had higher albumin levels and hemoglobin levels after nutritional pre-rehabilitation therapy compared with those before nutritional pre-rehabilitation therapy,and the albumin level in the EN+PN group was higher than that in the TPN group(35.7±4.4 g/L vs.33.5±5.4 g/L,t=-2.79,P=0.003);C-reactive protein in the EN+PN group was lower than that in the TPN group,but the difference was not statistically significant,6.3(1.1,20.5)mg/Lvs.9.9(2.3,30.0)mg/L,Z=-1.27,P=0.201;hemoglobin levels were higher in the EN+PN group than in the TPN group,112.5+15.5 g/L vs.105.3±18.8 g/L,t=-2.6,P=0.005.After PSM with hemoglobin and albumin as matching variables in a 1:2 ratio,there were 96 cases in the TPN group and 60 cases in the EN+PN group,respectively,and there was no statistically significant difference in the comparison of the albumin level and hemoglobin level between the two groups(both P＞0.05).After surgical treatment,the incidence of enterostomy(50.0％vs.30.0％,x2=6.1,P=0.022),superficial wound infection(27.1％vs.10.0％,x2=6.6,P=0.018),ileus(58.3％vs.33.3％,x2=9.2,P=0.004),and overall postoperative complications(70.8％vs.41.7％,x2=13.1,P=0.001)were higher in the TPN group compared with the EN+PN group.In addition,the TPN group had a longer hospital stay than the EN+PN group,11.0(7.0,16.0)d vs.8.0(6.7,11.0)d,Z=-2.4,P=0.013.Conclusions Both TPN and EN+PN can be used for nutritional prehabilitation and both can achieve satisfactory results,but nutritional prehabilitation with EN+PN may be better in terms of nutritional treatment effects and surgical outcomes,which deserves further research to validate.
一、概述 根据中国国家癌症中心发布的数据,2022年全国原发性肝癌发病人数36.77万,位列各种癌症新发病人数第4位(肺、结直肠、甲状腺、肝),发病率位列第5位(肺、女性乳腺、甲状腺、结直肠、肝);2022年因原发性肝癌死亡人数31.65万,死亡人数和死亡率均位列第2位(肺、肝)[1-2].原发性肝癌主要包括肝细胞癌(hepatocellular carcinoma,HCC)、肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)和混合型肝细胞癌-胆管癌(combined hepatocellular-cholangiocarcinoma,cHCC-CCA)3 种不同病理学类型,三者在发病机制、生物学行为、病理组织学、治疗方法以及预后等方面差异较大,其中HCC占75％～85％、ICC占10％～15％[3-4].本指南中的"肝癌"仅指HCC.
