Good day Ladies and Gentlemen, my name is Wanqin, working in the jiangxi provincial people’s hospital as a Geriatrician. It’s my pleasure to stand here to introduce one of our patients to you.
My topic is how to choose the way of nutrition therapy for an esophageal carcinoma patient.
The patient is a 97-year old man, who came to the hospital for esophageal carcinoma for a year. We found there was a cancer in the middle of his esophagus in May 2018，with CT scan. Then we performed gastroscopy, at the same time he was diagnosed pathologically of a poorly differentiated phosphoric cell carcinoma. We started a local radiotherapy on June. After 6 mouths we found that the cancer had metastasized to both the lung and liver.
The past history were coronary atherosclerotic heart disease; angina pectoris; cardiac function class 3;chronic obstructive pulmonary disease; osteoporosis; hypertension and orthostatic hypotension; etc.
His feeding condition: The patient could only have liquid food by the end of 2018. In March 2019, it was getting hard for him to drink water, which would reflux after swallowing.
We thought of some nutrition therapy options like: Giving him total parenteral nutrition? Could his heart tolerate this? We know the principle of nutrition therapy, which states when the gut works and can be used safely, use it. There are two feeding ways of enteral nutrition, which are oral and tube. The patient couldn’t swallow, tube feeding was the only way. We suggested the patient to accept PEG(percutaneous endoscopic gastrostomy) after proper evaluation, which is an invasive manipulation , but the best choice，he strongly refused it. According to guidelines , one of the contraindications of esophageal carcinoma is nasal tube feeding. After much thought, we put a nasogastric tube to feed. But the patient still refluxed seriously. Then we blindly inserted a nasojejunal tube at the bedside. The nutrition treatment of the patient was solved.
We want to show that sometimes contraindications can be overlooked or bypassed in medicine. Blindly inserting a nasojejunal tube at the bedside is a good way of nutrition therapy for a patient with esophageal carcinoma.
Thank you ！Thank you for your attention！
备注：苏州老年医学会议英语演讲稿
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