全胰臟切除病人的營養治療

Medical Nutrition Therapy in a Total Pancreatectomized Patient

胰臟癌病人在診斷前大多已呈現高度營養不良，某些特定病患必須接受全胰臟切除，來達到較佳的癌症治療效果，然而在胰臟癌惡病質高度發生威脅下，全胰臟切除病人必需同時面臨營養不良高風險，加上內分泌胰島素缺乏，及外分泌消化系統功能異常雙重壓力夾攻下，在營養供應及血糖控制之間必需重新達到平衡。本次個案在數年前接受惠普手術，持續追蹤；此次因局部腫瘤復發以根除性治療方法，接受全胰臟切除術，術後住院期問及出院之後介入營養治療。依病人腸胃道功能及耐受度，調整進食內容、依血糖波動調整胰島素劑量、依體重變化及未來化療，反覆重新修訂化療營養目標，再以體組成分析及生化數據來評值營養治療介入成效。病人在接受營養治療後，進食狀況良好、血糖趨於穩定、體重持續恢復，並接受計畫性術後化療。全胰切除手術病人相關代謝異常包括：內外分泌、術後併發高風險、營養不良高風險。本篇報告藉由此個案，綜述臨床上透過跨團隊合作介入營養治療，確保病人營養狀況、血糖控制及更好的醫療處置及提升照顧品質。

Most patients with pancreatic cancer are highly malnourished before diagnosed, and some specific patients must undergo total pancreatectomy to achieve better cancer therapy. Simultaneously, patients suffer the stress of high malnutrition risk, endocrine dysfunction such as insulin deficiency and abnormal gastric intestinal function suffer from the exocrine digestive disorder, due to the reason, nutritional supply and blood sugar control must be re-balanced. This case received Whipple procedure a few years ago, and stable by keeping follow-up; this time, due to the local tumor recurrence, implement radical therapy, and he underwent total pancreatectomy, and interventional the nutritional therapy during postoperative hospitalization and after discharge. According to the patient’s gastrointestinal function and tolerance, modifying the dietary content. Adjusted the insulin dose dependent on blood glucose fluctuations. Renovated the nutritional targets by the body weight trend and adjuvant chemotherapy plans. After receiving nutritional therapy, the patient had good eating status, stable blood sugar, sustained weight recovery, and received planned postoperative chemotherapy. Metabolic abnormalities associated with total pancreatectomy patients include: endocrine and exocrine dysfunction, postoperative complications and malnutrition high risks. This report reviews the clinical practice of intervening nutritional therapy through medical teams cooperation to ensure patients’ nutritional status, blood sugar control, enhanced medical treatment and quality.