Abstract:

Objective To develop a perioperative oral nutritional supplementation（ONS） protocol for rectal cancer patients undergoing stent-based diverting technique（SDT） and to evaluate its efficacy，providing a reference for the perioperative nutritional management of patients with rectal cancer. Methods Based on the best evidence and qualitative interviews on patient needs，a perioperative ONS protocol for rectal cancer patients undergoing SDT was developed and finalized by an expert consensus meeting. A total of 130 patients who underwent SDT for rectal cancer at a tertiary A comprehensive hospital in Hangzhou，China，from July 2022 to June 2025 were enrolled through convenience sampling. Patients admitted between January 2024 and June 2025（n=65） were assigned to an intervention group，while those admitted between July 2022 and December 2023（n=65） served as a historical control group. The intervention group received this protocol，whereas the control group received standard nutritional education and routine nursing care. The differences in the incidence of malnutrition，the compliance rate of taking ONS，the changing trends of hemoglobin and albumin，and the incidence rates of gastrointestinal intolerance and complications at 1 month after operation were compared between the 2 groups. Results During the intervention，a total of 5 cases dropped out. Finally，61 cases were included in the intervention group and 64 cases in the control group. A month after surgery，the incidence of malnutrition in the intervention group was lower than that in the control group（P<0.05）. The adherence to ONS was significantly higher in the intervention group compared with the control group（P<0.05）. After the operation，the concentrations of hemoglobin and albumin in both groups showed a trend of early decline followed by a slow recovery. The preoperative values were used as covariates for baseline correction，and the adjusted mean values of hemoglobin and albumin in the intervention group at each time point after surgery were higher than those in the control group，and the differences were statistically significant at 7 days and 1 month after surgery（P<0.05）. No statistically significant differences were observed between the 2 groups in the rates of gastrointestinal intolerance or postoperative complications（P>0.05）. Conclusion The perioperative ONS protocol for rectal cancer patients undergoing SDT developed in this study demonstrates scientific and practical value. This protocol can reduce the incidence of postoperative malnutrition，promote the recovery of albumin and hemoglobin，and does not increase the incidence of gastrointestinal intolerance and common complications.

Key words: Rectal Cancer, Stent-Based Diverting Technique, Perioperative Period, Oral Nutritional Supplement, Nursing Care

摘要：

目的 构建直肠癌支架法肠转流术患者围手术期口服营养补充方案，并验证其临床应用效果，为直肠癌患者围手术期营养管理提供参考。 方法 在最佳证据总结的基础上，结合半结构式访谈结果，并通过专家会议构建直肠癌支架法肠转流术患者围手术期口服营养补充方案。采用便利抽样法，选取2024年1月—2025年6月杭州市某三级甲等综合医院收治的直肠癌支架法肠转流术患者65例作为试验组，2022年7月—2023年12月纳入的65例为对照组。试验组实施口服营养补充方案，对照组实施常规营养健康教育和护理。比较两组术后营养不良的发生率、口服营养补充治疗依从率、血红蛋白及白蛋白浓度的变化趋势、胃肠不耐受发生率及并发症发生率的差异。 结果 干预期间，共脱落5例，最终试验组纳入61例，对照组纳入64例。术后1个月，试验组营养不良的发生率低于对照组，试验组口服营养补充治疗依从率高于对照组，差异具有统计学意义（P<0.05）；术后两组血红蛋白和白蛋白浓度均呈先下降后逐渐恢复的趋势，将术前值作为协变量进行基线校正，各时间点试验组校正后均值高于对照组，且术后第7天和术后1个月两组校正后均值差异有统计学意义（P<0.05）；两组胃肠不耐受和并发症发生率差异无统计学意义（P>0.05）。 结论 该研究构建的直肠癌支架法肠转流术患者围手术期口服营养补充方案具有较好的科学性和可行性，能够提高患者服用口服营养补充治疗依从率、降低术后营养不良发生率，促进术后白蛋白和血红蛋白浓度恢复，且不增加胃肠不耐受和常见并发症的发生率。

关键词: 直肠癌, 可降解肠道支架, 围手术期, 口服营养补充, 护理