術後空腸造口之營養治療

Medical Nutrition Therapy in Postoperative Jejunostomy

本篇文章探討上腸胃道術後營養狀況不良者，在建置空腸造口後，常見的營養問題及因應策略。術後病人常面臨營養不良的風險，特別是經歷大範圍組織或器官切除後。腸道營養為主要的營養支持方式之一，術後早期啟動腸道營養，不僅能改善病人的營養狀態，還能提升康復速度、有效降低術後併發症及縮短住院時間。術後當見的延遲性胃排空、傷口癒合及體蛋白修復等問題，急需補充各種營養素，小腸灌食成為重要的營養供應途徑，確保病人獲得足夠的熱量和營養。若預期病人術後一段時間，無法由口進食足夠營養，術中可建置空腸灌食管路，術後開始以10-40 ml/hr的速度啟動灌食，隨著耐受性的提高逐步增加，並在術後48-72小時達到所需熱量。關於灌食內容，初期可選擇元素配方，再轉為聚合配方，並需定期監測病人腸道適應、電解質平衡及管路脫位、阻塞及感染等併發症。對於術後面臨延遲性胃排空或腸道功能障礙的病人，使用小分子預解配方可增加吸收率，對於長期需要腸道營養的病人，透過經皮內視鏡空腸造口術（direct percutaneous endoscopic jejunostomy, DPEJ）或空腸延伸的胃造口管（percutaneous endoscopic transgastric jejunostomy, PEG-J）提供持續的營養支持也顯得尤為重要。早期介入腸道營養管理策咯，根據病人的具體情況，選擇合適的供給營養方式，可以促進其康復，並改善預後。

This article addressed common nutritional issues following the surgery for the upper gastrointestinal (UGI) tract disease, and the use of feeding jejunostomy for tackling these problems. The patients of UGI diseases are often at risk of malnutrition in the post-operative period, especially in those following extensive tissue or organ resection. Enteral nutrition has become one of the primary means of nutritional support for these patients, and the early adoption of enteral nutrition in the post-operative period not only improves the nutritional status of patients but also effectively reduces postoperative complications, shortens hospital stays, and enhances recovery rates. Common postoperative issues include delayed gastric emptying, wound healing, and body composition repair, which require various nutrients in a timely manner. Jejunal (post-pyloric) feeding becomes an important nutritional supply route to ensure that patients receive adequate calories and nutrition. If the patient is unable to resume sufficient oral intake for a period of time following surgery, a jejunal feeding tube can be created in the surgical procedure. Feeding can be initiated postoperatively at a rate of 10-40 ml/hr, and gradually be increased as tolerated. Aiming to reach the required caloric intake within 48-72 hours post-surgery. About the feeding content, an elemental formula is suggested firs, then shifted to a polymeric formula later, while regularly monitoring the patient’s intestinal adaptation, electrolyte balance, and complications such as tube displacement, obstruction, and infection. For patients facing delayed gastric emptying or intestinal dysfunction postoperatively, the use of small peptide pre-digested formulas can enhance absorption and reduce the burden on the upper gastrointestinal tract. For patients requiring long-term enteral nutrition, providing continuous nutritional support through percutaneous endoscopic jejunostomy(DPEJ) or PEG-J(percutaneous endoscopic gastrostomy with jejunal extension) is particularly important. In summary, early and tailored enteral nutrition is helpful to promote post-operative recovery and improve outcomes of the patients of UGI diseases.