许多患者由于与恶性肿瘤有关的原因而接受小肠和结肠手术,炎症性肠病(IBD),肠系膜缺血,和其他良性疾病,包括术后粘连,疝气,创伤,扭转,或者憩室.一些患者由于潜在的疾病而严重营养不良,进入手术室,而其他人则会出现并发症(例如,吻合口漏,脓肿,或狭窄)引起全身性炎症反应,可以增加其能量和蛋白质需求。最后,手术引起的解剖和功能变化会影响由于吸收不良或营养支持(NS)途径引起的营养状况。为这些患者提供NS的营养师需要了解这些后遗症背后的病理生理学,并与其他专业人员合作,包括外科医生,内科医生,护士,和药剂师。这篇综述的目的是概述不同类型的下胃肠道手术的营养和代谢后果以及营养师在提供全面患者护理中的作用。本文综述了小肠切除术对常量营养素和微量营养素吸收的影响。结肠切除术的影响(例如,回肠结肠切除术,低位前切除术,腹部手术切除,和直肠结肠切除术)需要特殊的饮食考虑,特定于造口患者的营养考虑,并为因IBD的局部和全身并发症而接受手术的患者的护理人员提供临床实践指南。最后,我们强调了营养师在短肠综合征和肠衰竭的挑战性治疗中的宝贵贡献.
Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.