1、胰十二指腸切除術后營養方式的選擇胰十二指腸切除術手術技術日益成熟（開腹、腹腔鏡、機器人）相關疾病的發病率/檢出率增高胰十二指腸切除術現狀并發癥率高（3050%）術后早期并發癥的發生與預后直接相關圍術期營養不良或存在營養風險的比例高（88%的患者存在中-重度營養風險）重度營養風險與術后并發癥率相關（50%）Malnutrition and pancreatic surgery: prevalence and outcomesJ. J Surg Oncol, 2013重視營養篩查和營養治療營養方案多種多樣Oral dietTotal parenteral nutrition (TPN)Jejuno

2、stomy tube Gastrogejunostomy tubeNasojejunal tubeStandard formulaImmunonutritionWith glutamineWith synbioticsSystematic review of five feeding routes after pancreatoduodenectomyJ. Br J Surg, 2013術后營養方式如何選擇？經口腸外管飼經口進食是最佳途徑？Systematic review of five feeding routes after pancreatoduodenectomyJ. Br J Su

3、rg, 2013Whipple術后口服營養方式安全，恢復正常飲食時間短 Guidelines (ERAS society, 2013)經口進食：現實很骨感Only 61% of patients were able to drink at day 1; 23% took solid food at day 3; and infusions were stopped at day 5 in 32%55%的患者能耐受流質飲食，53%的患者能耐受半流質或普食Perioperative nutritional support of patients undergoing pancreatic surg

4、ery in the age of ERASJ. Nutrition, 2014Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomyJ. World J Surg, 2014術后兩周，經口進食只能達到30%的目標熱量和41%目標氮量我們的稀飯、面條？Clinical feasibility and nutritional effects of early oral feeding after pancreaticoduodenectomyJ. Korean J Hepatob

5、iliary Pancreat Surg, 2014術后胃排空障礙（Delayed Gastric Emptying, DGE）Whipple術后DGE發生率高occurred in 340 (44.5 per cent) of 764 patients. 保留幽門術式DGE比例更高Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centreJ.

6、 Br J Surg, 2010管飼是否普遍需要？Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomyJ. Br J Surg, 2019結論：推薦管飼，促進胰十二指腸切除術后的恢復，減少并發癥管飼腸內營養不是完全的生理過程Eating is “a host of pleasurable phenomena”Food at will after pancreaticoduodenectomies. Re. Perioperative n

7、utritional support of patients undergoing pancreatic surgery in the age of ERASJ. Nutrition, 2015鼻飼管耐受性差43%的患者認為鼻飼管和胃管是最不舒適，最無法忍受的管飼增加DGE發生率Nasogastric tube versus gastrostomy tube for gastric decompression in abdominal surgery: a prospective, randomized trial comparing patients tube-related inconve

8、nienceJ. Langenbecks Arch Surg, 2001Utility of feeding jejunostomy tubes in pancreaticoduodenectomyJ. Am J Surg, 2017腸外營養被拋棄？TPN腸內營養補充性腸外營養補充性腸外營養（Supplementary Parenteral Nutrition, SPN）：腸內營養不足時，部分能量和蛋白質需求由腸外營養來補充的混合營養支持治療方式。合理的SPN能滿足能量和蛋白質需求，調整氮平衡，促進蛋白質合成，改善患者的營養狀況，降低并發癥率，改善臨床結局。消化道重建方式影響術后營養方式？Nu

9、tritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS)J. Surgery, 2018Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trialsJ. Int J Surg, 2016兩種吻合方式（胰胃/胰腸）術后胃排空障礙發生率無差異各種營養方式的特點營養方式優 點缺 點口服舒適、符合生理營養供給不足腸外營養營養供給調節自由，容易達到目標量并發癥多（導管相關性、代謝相關性、感染等）腸內營養（管飼）經鼻符合生理，保護腸道功能，可長期使用舒適性和耐受性差，達到目標量有一定困難造瘺相對舒適，保護腸道功能手術相關并發癥一般患者：口服+補充性腸外營