基于加速康复外科理念的肝癌围术期营养管理专家共识（2025版）

doi:10.12114/j.issn.1007-9572.2025.0378

摘要/Abstract

摘要： 肝癌患者因肝功能损伤、肿瘤消耗及治疗毒副作用等因素导致营养不良发生率高，显著增加术后并发症发生风险并缩短生存期。基于加速康复外科（ERAS）理念的多学科协作的围术期营养管理策略，已被证实能缩短住院时间并减少并发症。然而，目前国内外尚缺乏针对ERAS理念下肝癌围术期营养管理的专家共识。本共识通过整合循证证据与多学科临床实践经验，围绕肝癌患者营养筛查与评估方法、围术期营养方案、多学科协作路径等3大核心内容，构建规范化营养管理模式，形成包括围术期动态营养状况筛查评估、分阶段营养支持、运动干预及心理支持、多学科精准协作等围术期营养管理策略，旨在统一临床实践标准，改善肝癌患者营养状况及疾病预后。本共识适用于肝胆肿瘤相关科室及社区医院，为肝癌围术期患者提供加速康复外科理念下的科学化、个性化营养管理方案。

关键词: 肝肿瘤, 加速康复外科, 围术期管理, 营养干预, 多学科协作

Abstract:

Patients with hepatocellular carcinoma (HCC) frequently experience malnutrition due to impaired liver function, tumor-related cachexia, and treatment-related toxicities, which significantly increases postoperative complications and reduces survival rates. The enhanced recovery after surgery (ERAS) concept, implemented through multidisciplinary perioperative nutrition management, has been proven to shorten hospital stays and decrease complications. However, there remains a lack of specialized consensus on perioperative nutrition management for HCC patients within the ERAS framework. This consensus integrated evidence-based findings with multidisciplinary clinical experience, focusing on three core aspects: nutritional screening and assessment methods, perioperative nutrition protocols, and multidisciplinary collaboration pathways. It established a standardized nutrition management model, including dynamic perioperative nutritional status screening and assessment, staged nutritional support, exercise and psychological intervention, and precise multidisciplinary collaboration strategies. The aim was to standardize clinical practice, improve nutritional status, and enhance outcomes for HCC patients. This consensus was intended for hepatobiliary oncology departments and community hospitals, providing a scientific and personalized perioperative nutrition management plan under the ERAS concept for patients with liver cancer.

Key words: Liver neoplasms, Enhanced recovery after surgery, Perioperative management, Nutritional intervention, Multidisciplinary collaboration

中国康复医学会社区康复工作委员会. 基于加速康复外科理念的肝癌围术期营养管理专家共识（2025版）[J]. 中国全科医学, 2026, 29(08): 953-964. DOI: 10.12114/j.issn.1007-9572.2025.0378.
Chinese Rehabilitation Medicine Association Community Rehabilitation Working Committee. Expert Consensus on Perioperative Nutritional Management for Liver Cancer Based on the Enhanced Recovery after Surgery Concept (2025)[J]. Chinese General Practice, 2026, 29(08): 953-964. DOI: 10.12114/j.issn.1007-9572.2025.0378.

图/表 1

参考文献 133

[1]	LI Q R, DING C, CAO M M, et al. Global epidemiology of liver cancer 2022: an emphasis on geographic disparities[J]. Chin Med J(Engl), 2024, 137(19): 2334-2342. DOI: 10.1097/CM9.0000000000003264.
[2]	曹梦迪, 王红, 石菊芳, 等. 中国人群肝癌疾病负担:多数据源证据更新整合分析[J]. 中华流行病学杂志, 2020, 41(11): 1848-1858. DOI: 10.3760/cma.j.cn112338-20200306-00271.
[3]	WANG L, WANG X Y, WANG X J. The effectiveness of enteral nutrition for patients with primary liver cancer: a randomized controlled study protocol[J]. Medicine(Baltimore), 2021, 100(3): e23973. DOI: 10.1097/MD.0000000000023973.
[4]	WIE G A, CHO Y A, KIM S Y, et al. Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea[J]. Nutrition, 2010, 26(3): 263-268. DOI: 10.1016/j.nut.2009.04.013.
[5]	ABDELFATAH D, ALLAM R, MONEER M, et al. Nutritional assessment of Egyptian adults with hepatic and gastrointestinal malignancies: cross sectional study[J]. Egypt J Community Med, 2022. DOI: 10.21608/ejcm.2021.83418.1180.
[6]	刘萍, 宋春华. NRS 2002及MNA在原发性肝癌患者中应用的适用性比较[J]. 中国实用护理杂志, 2014, 30(11): 44-46.
[7]	LEE D U, WANG E, FAN G H, et al. Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals[J]. Br J Nutr, 2022, 128(4): 675-683. DOI: 10.1017/S0007114521003809.
[8]	NOBA L, RODGERS S, CHANDLER C, et al. Enhanced recovery after surgery(ERAS)reduces hospital costs and improve clinical outcomes in liver surgery: a systematic review and meta-analysis[J]. J Gastrointest Surg, 2020, 24(4): 918-932. DOI: 10.1007/s11605-019-04499-0.
[9]	LJUNGQVIST O, SCOTT M, FEARON K C. Enhanced recovery after surgery: a review[J]. JAMA Surg, 2017, 152(3): 292-298. DOI: 10.1001/jamasurg.2016.4952.
[10]	REMINGTON J H, BARGEN J A, PEMBERTON J D. Nutritional rehabilitation of surgical patients[J]. Ann Surg, 1947, 125(1): 115-118.
[11]	余恺涛, 贾杰. 全周期康复视角下的肝癌相关指南及专家共识解读[J]. 中国医刊, 2022, 57(1): 18-21.
[12]	KAIBORI M, MATSUI K, SHIMADA M, et al. Update on perioperative management of patients undergoing surgery for liver cancer[J]. Ann Gastroenterol Surg, 2021, 6(3): 344-354. DOI: 10.1002/ags3.12529.
[13]	LI X Y, YUAN Q, GENG L R, et al. Quality assessment of the clinical practice guidelines of ostomy care based on the AGREEⅡ instrument[J]. Front Public Health, 2022, 10: 856325. DOI: 10.3389/fpubh.2022.856325.
[14]	SHEA B J, GRIMSHAW J M, WELLS G A, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews[J]. BMC Med Res Methodol, 2007, 7: 10. DOI: 10.1186/1471-2288-7-10.
[15]	ZHENG J L, ZHAO L G, DONG J W, et al. The role of dietary factors in nonalcoholic fatty liver disease to hepatocellular carcinoma progression: a systematic review[J]. Clin Nutr, 2022, 41(10): 2295-2307. DOI: 10.1016/j.clnu.2022.08.018.
[16]	GEORGE E S, SOOD S, BROUGHTON A, et al. The association between diet and hepatocellular carcinoma: a systematic review[J]. Nutrients, 2021, 13(1): 172. DOI: 10.3390/nu13010172.
[17]	HUANG T H, HSIEH C C, KUO L M, et al. Malnutrition associated with an increased risk of postoperative complications following hepatectomy in patients with hepatocellular carcinoma[J]. HPB: Oxford, 2019, 21(9): 1150-1155. DOI: 10.1016/j.hpb.2019.01.003.
[18]	JIN W Q, JIANG S M, CHEN A K, et al. Effect of preoperative malnutrition based on albumin and BMI on hepatocellular carcinoma surgery and prediction of risk factors of complications[J]. J Gastrointest Cancer, 2024, 55(2): 511-518. DOI: 10.1007/s12029-023-01008-0.
[19]	OMIYA S, URADE T, KOMATSU S, et al. Impact of GLIM criteria-based malnutrition diagnosis on outcomes following liver resection for hepatocellular carcinoma[J]. HPB: Oxford, 2023, 25(12): 1555-1565. DOI: 10.1016/j.hpb.2023.08.012.
[20]	MARTÍNEZ-ORTEGA A J, PIÑAR-GUTIÉRREZ A, SERRANO-AGUAYO P, et al. Perioperative nutritional support: a review of current literature[J]. Nutrients, 2022, 14(8): 1601. DOI: 10.3390/nu14081601.
[21]	吕倩, 谢海英, 苏虹虹, 等. 肝癌病人术前营养支持的研究进展[J]. 循证护理, 2022, 8(11): 1481-1484.
[22]	REBER E, SCHÖNENBERGER K A, VASILOGLOU M F, et al. Nutritional risk screening in cancer patients: the first step toward better clinical outcome[J]. Front Nutr, 2021, 8: 603936. DOI: 10.3389/fnut.2021.603936.
[23]	REBER E, GOMES F, VASILOGLOU M F, et al. Nutritional risk screening and assessment[J]. J Clin Med, 2019, 8(7): 1065. DOI: 10.3390/jcm8071065.
[24]	YU J X, SOH K L, HE L P, et al. Development of a short-term nutritional risk prediction model for hepatocellular carcinoma patients: a retrospective cohort study[J]. Sci Rep, 2024, 14(1): 3921. DOI: 10.1038/s41598-024-54456-4.
[25]	WANG P P, TAN Y M, SOH K L, et al. Nutrition risk screening 2002 for adult cancer patients: a systematic review and meta-analysis[J]. Nutr Cancer, 2024, 76(7): 573-583. DOI: 10.1080/01635581.2024.2352901.
[26]	HUANG S L, WANG S J, XIE Y K, et al. Application of NRS 2002 in preoperative nutritional screening for patients with liver cancer[J]. J Oncol, 2021, 2021: 8943353. DOI: 10.1155/2021/8943353.
[27]	CRESTANI M S, GRASSI T, STEEMBURGO T. Methods of nutritional assessment and functional capacity in the identification of unfavorable clinical outcomes in hospitalized patients with cancer: a systematic review[J]. Nutr Rev, 2022, 80(4): 786-811. DOI: 10.1093/nutrit/nuab090.
[28]	XIE L, WANG S, ZHOU L Y, et al. Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis[J]. PLoS One, 2020, 15(2): e0229396. DOI: 10.1371/journal.pone.0229396.
[29]	TAN S Q, JIANG J, QIU L L, et al. Prevalence of malnutrition in patients with hepatocellular carcinoma: a comparative study of GLIM criteria, NRS 2002, and PG-SGA, and identification of independent risk factors[J]. Nutr Cancer, 2024, 76(4): 335-344. DOI: 10.1080/01635581.2024.2314317.
[30]	GIL-ANDRÉS D, CABAÑAS-ALITE L. A narrative review comparing nutritional screening tools in outpatient management of cancer patients[J]. Nutrients, 2024, 16(5): 752. DOI: 10.3390/nu16050752.
[31]	TORBAHN G, STRAUSS T, SIEBER C C, et al. Nutritional status according to the mini nutritional assessment(MNA)® as potential prognostic factor for health and treatment outcomes in patients with cancer - a systematic review[J]. BMC Cancer, 2020, 20(1): 594. DOI: 10.1186/s12885-020-07052-4.
[32]	PLAUTH M, BERNAL W, DASARATHY S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2): 485-521. DOI: 10.1016/j.clnu.2018.12.022.
[33]	WU Y C, ZHU Y G, FENG Y L, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002[J]. Br J Nutr, 2020, 124(12): 1293-1302. DOI: 10.1017/S0007114520002366.
[34]	HE Y M, WANG Z M, WU S Y, et al. Screening and assessment of malnutrition in patients with liver cirrhosis[J]. Front Nutr, 2024, 11: 1398690. DOI: 10.3389/fnut.2024.1398690.
[35]	MCFARLANE M, HAMMOND C, ROPER T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis[J]. Clin Nutr ESPEN, 2018, 23: 156-161. DOI: 10.1016/j.clnesp.2017.10.009.
[36]	WANG R Z, HUANG L H, XU M, et al. Comparison of different nutritional screening tools in nutritional screening of patients with cirrhosis: a cross-sectional observational study[J]. Heliyon, 2024, 10(10): e30339. DOI: 10.1016/j.heliyon.2024.e30339.
[37]	MOHILE S G, DALE W, SOMERFIELD M R, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology summary[J]. J Oncol Pract, 2018, 14(7): 442-446. DOI: 10.1200/JOP.18.00180.
[38]	DECOSTER L, PUYVELDE K V, MOHILE S, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations[J]. Ann Oncol, 2015, 26(2): 288-300. DOI: 10.1093/annonc/mdu210.
[39]	RAVASCO P. Nutrition in cancer patients[J]. J Clin Med, 2019, 8(8): 1211. DOI: 10.3390/jcm8081211.
[40]	ZHOU H J, DENG L J, WANG T, et al. Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREEⅡ instrument[J]. Support Care Cancer, 2021, 29(6): 2885-2893. DOI: 10.1007/s00520-021-06094-z.
[41]	MIWA T K, HANAI T, NISHIMURA K, et al. Nutritional assessment using subjective global assessment identifies energy malnutrition and predicts mortality in patients with liver cirrhosis[J]. Sci Rep, 2025, 15(1): 4831. DOI: 10.1038/s41598-025-89803-6.
[42]	PENTIUK N, MOTSIUK V. Evaluation of nutritional status in patients with liver cirrhosis. Validity and prognostic value of the Patient-Generated Subjective Global Assessment[J]. Prz Gastroenterol, 2023, 18(3): 327-333. DOI: 10.5114/pg.2022.119964.
[43]	JAGER-WITTENAAR H, OTTERY F D. Assessing nutritional status in cancer: role of the patient-generated subjective global assessment[J]. Curr Opin Clin Nutr Metab Care, 2017, 20(5): 322-329. DOI: 10.1097/MCO.0000000000000389.
[44]	CHONMAITREE P, SUDCHAROEN A, POONYAM P, et al. Comparison of Patient-Generated Subjective Global Assessment(PG-SGA)and Mini Nutritional Assessment(MNA)for nutritional assessment in hepatocellular carcinoma patients[J]. Support Care Cancer, 2025, 33(2): 116. DOI: 10.1007/s00520-025-09176-4.
[45]	ALDANA LEDESMA J M, VÁZQUEZ RODRÍGUEZ D, LAZCANO BECERRA M, et al. Comparison of different tools for the evaluation of malnutrition and sarcopenia in patients with liver cirrhosis[J]. Nutr Hosp, 2023, 40(2): 340-346. DOI: 10.20960/nh.03837.
[46]	BARAZZONI R, JENSEN G L, CORREIA M I T D, et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition(GLIM)diagnosis of malnutrition[J]. Clin Nutr, 2022, 41(6): 1425-1433. DOI: 10.1016/j.clnu.2022.02.001.
[47]	CEDERHOLM T, JENSEN G L, CORREIA M D, et al. GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community[J]. J Cachexia Sarcopenia Muscle, 2019, 10(1): 207-217. DOI: 10.1002/jcsm.12383.
[48]	CEDERHOLM T, JENSEN G L, CORREIA M I T D, et al. The GLIM consensus approach to diagnosis of malnutrition: a 5-year update[J]. Clin Nutr, 2025, 49: 11-20. DOI: 10.1016/j.clnu.2025.03.018.
[49]	SCHÜTTE K, TIPPELT B, SCHULZ C, et al. Malnutrition is a prognostic factor in patients with hepatocellular carcinoma(HCC)[J]. Clin Nutr, 2015, 34(6): 1122-1127. DOI: 10.1016/j.clnu.2014.11.007.
[50]	CORTEZ A F, DE ALMEIDA V P, CORRÊA B B, et al. Nutritional assessment, handgrip strength and adductor pollicis muscle thickness in patients with chronic viral hepatitis[J]. Clin Nutr Exp, 2020, 29: 49-61. DOI: 10.1016/j.yclnex.2019.11.002.
[51]	PEDRO J, MARTUCCI R, MONTEIRO G, et al. Mid-upper arm circumference in hospitalized pediatric patients with cancer: is there an association with malnutrition?[J]. Nutr Clin Pract, 2023, 38(5): 1133-1141. DOI: 10.1002/ncp.11039.
[52]	GORT-VAN DIJK D, WEERINK L B M, MILOVANOVIC M, et al. Bioelectrical impedance analysis and mid-upper arm muscle circumference can be used to detect low muscle mass in clinical practice[J]. Nutrients, 2021, 13(7): 2350. DOI: 10.3390/nu13072350.
[53]	KELLY C M, SHAHROKNI A. Moving beyond karnofsky and ECOG performance status assessments with new technologies[J]. J Oncol, 2016, 2016: 6186543. DOI: 10.1155/2016/6186543.
[54]	LI T, LI B, TAN L, et al. Reminiscence therapy as a potential method to improve psychological health and quality of life in elderly hepatocellular carcinoma patients: a randomized, controlled trial[J]. Front Surg, 2022, 9: 873843. DOI: 10.3389/fsurg.2022.873843.
[55]	WONDIE Y, MEHNERT A, HINZ A. The Hospital Anxiety and Depression Scale(HADS) applied to Ethiopian cancer patients[J]. PLoS One, 2020, 15(12): e0243357. DOI: 10.1371/journal.pone.0243357.
[56]	LAI J C, VOLK M L, STRASBURG D, et al. Performance-based measures associate with frailty in patients with end-stage liver disease[J]. Transplantation, 2016, 100(12): 2656-2660. DOI: 10.1097/TP.0000000000001433.
[57]	YEE X S, NG Y S, ALLEN J C, et al. Performance on sit-to-stand tests in relation to measures of functional fitness and sarcopenia diagnosis in community-dwelling older adults[J]. Eur Rev Aging Phys Act, 2021, 18(1): 1. DOI: 10.1186/s11556-020-00255-5.
[58]	FANG E H, WANG X L, FENG J X, et al. The prognostic role of Glasgow prognostic score and C-reactive protein to albumin ratio for sarcoma: a system review and meta-analysis[J]. Dis Markers, 2020, 2020: 8736509. DOI: 10.1155/2020/8736509.
[59]	廖建洲. 肝癌病患中, C-反应蛋白在存活率及预后结果的分析[D]. 台中: 中山医学大学医学研究所, 2016: 1-44.
[60]	ZHANG J, ZHANG C B, LI Q X, et al. C-reactive protein/albumin ratio is an independent prognostic predictor of survival in advanced cancer patients receiving palliative care[J]. J Palliat Med, 2019, 22(12): 1536-1545. DOI: 10.1089/jpm.2019.0102.
[61]	MEDHAT A S, AHMED A O, AHMED F T, et al. Creatinine height index as a predictor of nutritional status among patients with liver cirrhosis[J]. J Public Health Epidemiol, 2016, 8(10): 220-228. DOI: 10.5897/jphe2016.0850.
[62]	LI J D, XU X F, HAN J, et al. Preoperative prealbumin level as an independent predictor of long-term prognosis after liver resection for hepatocellular carcinoma: a multi-institutional study[J]. HPB(Oxford), 2019, 21(2): 157-166. DOI: 10.1016/j.hpb.2018.06.1803.
[63]	LI J D, DIAO Y K, LI J, et al. Association between preoperative prealbumin level and postoperative mortality and morbidity after hepatic resection for hepatocellular carcinoma: a multicenter study from a HBV-endemic area[J]. Am J Surg, 2021, 221(5): 1024-1032. DOI: 10.1016/j.amjsurg.2020.08.036.
[64]	BRETSCHER C, BUERGIN M, GURZELER G, et al. Association between prealbumin, all-cause mortality, and response to nutrition treatment in patients at nutrition risk: Secondary analysis of a randomized controlled trial[J]. JPEN J Parenter Enteral Nutr, 2023, 47(3): 408-419. DOI: 10.1002/jpen.2470.
[65]	ZHANG H Y, LI D, LI J. Prognostic significance of preoperative prognostic nutritional index in hepatocellular carcinoma after curative hepatectomy: a meta-analysis and systemic review[J]. Front Nutr, 2024, 11: 1433528. DOI: 10.3389/fnut.2024.1433528.
[66]	YAN L, NAKAMURA T, CASADEI-GARDINI A, et al. Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review[J]. Ann Transl Med, 2021, 9(21): 1630. DOI: 10.21037/atm-21-4528.
[67]	FAN X X, CHEN G Q, LI Y R, et al. The preoperative prognostic nutritional index in hepatocellular carcinoma after curative hepatectomy: a retrospective cohort study and meta-analysis[J]. J Invest Surg, 2021, 34(8): 826-833. DOI: 10.1080/08941939.2019.1698679.
[68]	FARIAS C L, CAMPOS D J, BONFIN C M, et al. Phase angle from BIA as a prognostic and nutritional status tool for children and adolescents undergoing hematopoietic stem cell transplantation[J]. Clin Nutr, 2013, 32(3): 420-425. DOI: 10.1016/j.clnu.2012.09.003.
[69]	PAN J Y, CHEN S C, TIAN G, et al. Preoperative albumin-bilirubin grade with prognostic nutritional index predicts the outcome of patients with early-stage hepatocellular carcinoma after percutaneous radiofrequency ablation[J]. Front Med(Lausanne), 2020, 7: 584871. DOI: 10.3389/fmed.2020.584871.
[70]	GENTON L, HERRMANN F R, SPÖRRI A, et al. Association of mortality and phase angle measured by different bioelectrical impedance analysis(BIA) devices[J]. Clin Nutr, 2018, 37(3): 1066-1069. DOI: 10.1016/j.clnu.2017.03.023.
[71]	LINDQVIST C, BRISMAR T B, MAJEED A, et al. Assessment of muscle mass depletion in chronic liver disease: Dual-energy X-ray absorptiometry compared with computed tomography[J]. Nutrition, 2019, 61: 93-98. DOI: 10.1016/j.nut.2018.10.031.
[72]	VANGELOV B, BAUER J, KOTEVSKI D, et al. The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review[J]. Br J Nutr, 2022, 127(5): 722-735. DOI: 10.1017/S0007114521001446.
[73]	KAZEMI-BAJESTANI S M R, MAZURAK V C, BARACOS V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes[J]. Semin Cell Dev Biol, 2016, 54: 2-10. DOI: 10.1016/j.semcdb.2015.09.001.
[74]	ZHAO R N, HOU X H, NIU Y S, et al. Effect of the Home to Hospital to Home nutrition management program on postoperative liver cancer patients: a single-center randomized controlled study[J]. Medicine(Baltimore), 2023, 102(49): e36648. DOI: 10.1097/MD.0000000000036648.
[75]	SÁNCHEZ-TORRALVO F J, RUIZ-GARCÍA I, CONTRERAS-BOLÍVAR V, et al. CT-determined sarcopenia in GLIM-defined malnutrition and prediction of 6-month mortality in cancer inpatients[J]. Nutrients, 2021, 13(8): 2647. DOI: 10.3390/nu13082647.
[76]	LAMBERT J E, HAYES L D, KEEGAN T J, et al. The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery: a PRISMA-accordant meta-analysis[J]. Ann Surg, 2021, 274(1): 70-77. DOI: 10.1097/SLA.0000000000004527.
[77]	GILLIS C, DAVIES S J, CARLI F, et al. Current landscape of nutrition within prehabilitation oncology research: a scoping review[J]. Front Nutr, 2021, 8: 644723. DOI: 10.3389/fnut.2021.644723.
[78]	刘敏艳, 杨秀琴, 何业萍, 等. 加速康复外科肝癌切除术患者全程胃肠道管理方案的构建及应用[J]. 医学理论与实践, 2023, 36(5): 862-864. DOI: 10.19381/j.issn.1001-7585.2023.05.055.
[79]	石梅. 基于营养支持的加速康复外科护理在肝癌患者围手术期中的应用[J]. 婚育与健康, 2024(2): 154-156.
[80]	LI X Q, LIANG Y, HUANG C F, et al. Advancements in nutritional diagnosis and support strategies during the perioperative period for patients with liver cancer[J]. World J Gastrointest Surg, 2024, 16(8): 2409-2425. DOI: 10.4240/wjgs.v16.i8.2409.
[81]	BERLANA D. Parenteral nutrition overview[J]. Nutrients, 2022, 14(21): 4480. DOI: 10.3390/nu14214480.
[82]	张坤, 朱锦德, 吕昕亮, 等. 补充性肠外营养在加速康复外科肝癌患者术后的应用[J]. 中华普通外科杂志, 2019, 34(8): 693-695. DOI: 10.3670.cma.j.issn.1007-631X.2019.00.013.
[83]	郑惊雷, 王在国, 陈刘镇, 等. 肝癌手术患者应用快速康复外科措施的效果分析[J]. 中华临床医师杂志(电子版), 2016, 10(1): 16-19.
[84]	YAN X P, LIU L X, ZHANG Y M, et al. Perioperative enteral nutrition improves postoperative recovery for patients with primary liver cancer: a randomized controlled clinical trial[J]. Nutr Cancer, 2021, 73(10): 1924-1932. DOI: 10.1080/01635581.2020.1814824.
[85]	CHALLINE A, RIVES-LANGE C, DANOUSSOU D, et al. Impact of oral immunonutrition on postoperative morbidity in digestive oncologic surgery: a nation-wide cohort study[J]. Ann Surg, 2021, 273(4): 725-731. DOI: 10.1097/SLA.0000000000003282.
[86]	CIACIO O, VORON T, PITTAU G, et al. Interest of preoperative immunonutrition in liver resection for cancer: study protocol of the PROPILS trial, a multicenter randomized controlled phase Ⅳ trial[J]. BMC Cancer, 2014, 14: 980. DOI: 10.1186/1471-2407-14-980.
[87]	XU Y, WEI F X. A retrospective study of enteral nutrition on immune and inflammatory factors after liver cancer surgery[J]. Medicine(Baltimore), 2021, 100(44): e27718. DOI: 10.1097/MD.0000000000027718.
[88]	TAKESHITA S, ICHIKAWA T, NAKAO K, et al. A snack enriched with oral branched-chain amino acids prevents a fall in albumin in patients with liver cirrhosis undergoing chemoembolization for hepatocellular carcinoma[J]. Nutr Res, 2009, 29(2): 89-93. DOI: 10.1016/j.nutres.2008.12.005.
[89]	KIKUCHI Y, HIROSHIMA Y, MATSUO K, et al. A randomized clinical trial of preoperative administration of branched-chain amino acids to prevent postoperative ascites in patients with liver resection for hepatocellular carcinoma[J]. Ann Surg Oncol, 2016, 23(11): 3727-3735. DOI: 10.1245/s10434-016-5348-3.
[90]	陈桂香, 胡燊. 基于快速康复外科(ERAS)理念的运动—营养管理模式在原发性肝癌(肝癌)合并糖尿病患者围手术期护理中的应用效果观察[J]. 糖尿病新世界, 2020, 23(1): 126-127, 130. DOI: 10.16658/j.cnki.1672-4062.2020.01.126.
[91]	PLAZ TORRES M C, JAFFE A, PERRY R, et al. Diabetes medications and risk of HCC[J]. Hepatology, 2022, 76(6): 1880-1897. DOI: 10.1002/hep.32439.
[92]	冯霞, 夏燕, 卞红艳, 等. 微生态调节对乙型肝炎病毒相关肝细胞癌术后早期肠功能恢复的研究[J]. 中华临床感染病杂志, 2018, 11(1): 47-50.
[93]	CHRISTOPHER C N, KANG D W, WILSON R L, et al. Exercise and nutrition interventions for prehabilitation in hepato-pancreato-biliary cancers: a narrative review[J]. Nutrients, 2023, 15(24): 5044. DOI: 10.3390/nu15245044.
[94]	WALCOTT-SAPP S, BILLINGSLEY K G. Preoperative optimization for major hepatic resection[J]. Langenbecks Arch Surg, 2018, 403(1): 23-35. DOI: 10.1007/s00423-017-1638-x.
[95]	黄帅, 陆丽华. 强化心理干预对肝癌患者心理状态和生存质量的影响[J]. 中西医结合护理, 2023, 9(3): 156-160. DOI: 10.55111/j.issn2709-1961.202209014.
[96]	FANG X, FU L X, HE Y, et al. Improving liver cancer care: the effects of perma-based psychological and nutritional interventions[J]. Curr Top Nutraceutical Res, 2024, 22(2): 531-537. DOI: 10.37290/ctnr2641-452x.22:531-537.
[97]	ZHANG H R, LI S X, YUAN M M, et al. Exploring early postoperative core symptoms in Chinese patients with primary liver cancer: a cross-sectional and longitudinal network analysis[J]. Support Care Cancer, 2025, 33(2): 104. DOI: 10.1007/s00520-024-09141-7.
[98]	COTOGNI P, BOZZETTI F, GOLDWASSER F, et al. Supplemental parenteral nutrition in cancer care: why, who, when[J]. Ther Adv Med Oncol, 2022, 14: 17588359221113691. DOI: 10.1177/17588359221113691.
[99]	YUAN Y, ZHONG W, GAO H M, et al. Blind nasoenteric tube placement risks: a case report of misplacement into the pleural cavity[J]. Medicine(Baltimore), 2025, 104(2): e41101. DOI: 10.1097/MD.0000000000041101.
[100]	HOETER K, HEINRICH S, WOLLSCHLÄGER D, et al. The optimal fluid strategy matters in liver surgery: a retrospective single centre analysis of 666 consecutive liver resections[J]. J Clin Med, 2023, 12(12): 3962. DOI: 10.3390/jcm12123962.
[101]	HU Y J, ZHANG X X, LIANG S Q, et al. Goal-directed fluid therapy during hepatectomy a systematic review and meta-analysis[J]. SSRN Journal, 2021. DOI: 10.2139/ssrn.3984082.
[102]	CAMPBELL G, ALDERSON P, SMITH A F, et al. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia[J]. Cochrane Database Syst Rev, 2015, 2015(4): CD009891. DOI: 10.1002/14651858.CD009891.pub2.
[103]	TANDON M, KARNA S T, PANDEY C K, et al. Multimodal temperature management during donor hepatectomy under combined general anaesthesia and neuraxial analgesia: Retrospective analysis[J]. Indian J Anaesth, 2018, 62(6): 431-435. DOI: 10.4103/ija.IJA_123_18.
[104]	YI N X, WANG Z L, CUI R. Warming with a composite warming strategy reduces intraoperative hypothermia in patients undergoing open hepatectomy for liver cancer: a randomized controlled study[J]. Medicine(Baltimore), 2025, 104(8): e41616. DOI: 10.1097/MD.0000000000041616.
[105]	WEIMANN A, BRAGA M, CARLI F, et al. ESPEN practical guideline: Clinical nutrition in surgery[J]. Clin Nutr, 2021, 40(7): 4745-4761. DOI: 10.1016/j.clnu.2021.03.031.
[106]	WEIMANN A, BRAGA M, CARLI F, et al. ESPEN guideline: Clinical nutrition in surgery[J]. Clin Nutr, 2017, 36(3): 623-650. DOI: 10.1016/j.clnu.2017.02.013.
[107]	乔晓斐, 荚卫东, 韩梅, 等. 口服营养补充在肝癌肝切除患者术后加速康复中的应用[J]. 中华肝脏外科手术学电子杂志, 2019, 8(4): 315-319.
[108]	WANG L, WANG X Y, WANG X J. The effectiveness of enteral nutrition for patients with primary liver cancer[J]. Medicine, 2021, 100(3): e23973. DOI: 10.1097/md.0000000000023973.
[109]	QIU J J, WANG Y H. Effect of accelerated rehabilitation combined with enteral nutrition on gastrointestinal function recovery after hepatectomy[J]. Support Care Cancer, 2022, 30(11): 8927-8933. DOI: 10.1007/s00520-022-07290-1.
[110]	GAO L B, TIAN H, WANG X G, et al. Early enteral and parenteral nutritional support after hepatectomy in patients with hepatic carcinoma: a systematic review and meta-analysis[J]. Onco Targets Ther, 2015, 8: 623-631. DOI: 10.2147/OTT.S73275.
[111]	BLUMENSTEIN I, SHASTRI Y M, STEIN J. Gastroenteric tube feeding: techniques, problems and solutions[J]. World J Gastroenterol, 2014, 20(26): 8505-8524. DOI: 10.3748/wjg.v20.i26.8505.
[112]	段飞, 李学民, 陈靓, 等. 肝细胞癌精准肝切除术后早期肠内营养与联合营养支持治疗的前瞻性研究[J]. 中华消化外科杂志, 2017, 16(12): 1191-1198. DOI: 10.3760/cma.j.issn.1673-9752.2017.12.006.
[113]	HUANG H, ZHOU P, LI J, et al. Enhanced recovery after surgery in primary liver cancer patients undergoing hepatectomy: experience from a large tertiary hospital in China[J]. BMC Surg, 2023, 23(1): 185. DOI: 10.1186/s12893-023-02040-4.
[114]	骆鹏飞, 荚卫东, 许戈良, 等. 加速康复外科理念在原发性肝癌患者肝切除围手术期中的应用[J]. 中华普通外科杂志, 2015, 30(11): 862-865. DOI: 10.3760/cma.j.issn.1007-631X.2015.11.007.
[115]	EMILE S H, HORESH N, GAROUFALIA Z, et al. Strategies to reduce ileus after colorectal surgery: a qualitative umbrella review of the collective evidence[J]. Surgery, 2024, 175(2): 280-288. DOI: 10.1016/j.surg.2023.10.005.
[116]	PAN W Y, CAI S N, LATOUR J M, et al. External use of Mirabilite combined with Lactulose improves postoperative gastrointestinal mobility among older patients undergoing abdominal surgery[J]. J Adv Nurs, 2021, 77(2): 755-762. DOI: 10.1111/jan.14640.
[117]	SARMIENTO-ALTAMIRANO D, ARCE-JARA D, BALAREZO-GUERRERO P, et al. Reduction of postoperative ileus in gastrointestinal surgery: systematic review and meta-analysis[J]. J Gastrointest Surg, 2025, 29(3): 101960. DOI: 10.1016/j.gassur.2025.101960.
[118]	TAN S J, MENG Q Y, JIANG Y, et al. Impact of oral nutritional supplements in post-discharge patients at nutritional risk following colorectal cancer surgery: a randomised clinical trial[J]. Clin Nutr, 2021, 40(1): 47-53. DOI: 10.1016/j.clnu.2020.05.038.
[119]	ROWLEY A, ADIAMAH A, KUSHAIRI A, et al. The effect of post-discharge oral nutritional supplements on outcomes after gastrointestinal surgery: a systematic review and meta-analysis[J]. Clin Nutr, 2023, 42(7): 1189-1201. DOI: 10.1016/j.clnu.2023.04.028.
[120]	NUNTHANAWANICH P, WICHANSAWAKUN S, LUANGJINDA C, et al. Effectiveness of web applications on improving nutritional status of patients with colorectal cancer[J]. Nutrients, 2024, 16(3): 408. DOI: 10.3390/nu16030408.
[121]	MUNK T, SVENDSEN J A, KNUDSEN A W, et al. A multimodal nutritional intervention after discharge improves quality of life and physical function in older patients-a randomized controlled trial[J]. Clin Nutr, 2021, 40(11): 5500-5510. DOI: 10.1016/j.clnu.2021.09.029.
[122]	TERP R, JACOBSEN K O, KANNEGAARD P, et al. A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk-a randomized controlled trial[J]. Clin Rehabil, 2018, 32(7): 930-941. DOI: 10.1177/0269215518765912.
[123]	李艺, 范俊雅, 陈丽. 基于快速康复外科理念的运动-营养管理模式干预对原发性肝癌合并糖尿病病人营养、免疫及生活质量的影响[J]. 全科护理, 2022, 20(9): 1236-1240.
[124]	TAN Y P, LI J Q, LIU X X, et al. Advances in multidisciplinary team-based collaborative care models in the nutritional management of patients with hepatocellular carcinoma[J]. Acad J Med Health Sci, 2023, 4(1): 1-6. DOI: 10.25236/ajmhs.2023.040101.
[125]	GUNASEKARAN G, BEKKI Y, LOURDUSAMY V, et al. Surgical treatments of hepatobiliary cancers[J]. Hepatology, 2021, 73(Suppl 1): 128-136. DOI: 10.1002/hep.31325.
[126]	MUNGROOP T H, GEERTS B F, VEELO D P, et al. Fluid and pain management in liver surgery(MILESTONE): a worldwide study among surgeons and anesthesiologists[J]. Surgery, 2019, 165(2): 337-344. DOI: 10.1016/j.surg.2018.08.013.
[127]	ZHANG X L, MA H Y. Comprehensive influence of individualized nutrition support and nursing strategy on rehabilitation of patients with liver cancer after operation[J]. World J Gastrointest Surg, 2025, 17(2): 101297. DOI: 10.4240/wjgs.v17.i2.101297.
[128]	OBUKHOVA O, KURMUKOV I, YUNAEV G S. The role of nutritional support in the treatment of liver malignancies[J]. Clinical Nutrition and Metabolism, 2020, 1(3): 117-126.
[129]	GAO B X, ZHAO W W, SU W, et al. Exercise prehabilitation for patients with end-stage liver disease: a best practice implementation project[J]. JBI Evid Implement, 2023, 21(2): 128-137. DOI: 10.1097/XEB.0000000000000372.
[130]	CHEN H Y, LU H X, ZHOU H M, et al. Modular multimodal hospital-home chain physical activity rehabilitation programme(3M2H-PARP) in liver cancer: a protocol for a randomised controlled trial[J]. BMJ Open, 2024, 14(5): e083228. DOI: 10.1136/bmjopen-2023-083228.
[131]	RAUCH S, MILLER C, BRÄUER A, et al. Perioperative hypothermia-a narrative review[J]. Int J Environ Res Public Health, 2021, 18(16): 8749. DOI: 10.3390/ijerph18168749.
[132]	WILLIAMS D G A, VILLALTA E, ARONSON S, et al. Tutorial: development and implementation of a multidisciplinary preoperative nutrition optimization clinic[J]. JPEN J Parenter Enteral Nutr, 2020, 44(7): 1185-1196. DOI: 10.1002/jpen.1824.
[133]	YINUSA G, SCAMMELL J, MURPHY J, et al. Multidisciplinary provision of food and nutritional care to hospitalized adult in-patients: a scoping review[J]. J Multidiscip Healthc, 2021, 14: 459-491. DOI: 10.2147/JMDH.S255256.