腹部手术生长抑素类药物规范应用的研究进展
Research advances of standardized application of somatostatin after abdominal operation
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摘要:
腹部手术作为临床常见的手术类型,术后治疗和康复一直是外科医师高度关注的重点。生长抑素类药物常用于腹部手术后出血、门静脉高压症出血、急性胰腺炎等并发症的预防性治疗。临床实践中,生长抑素类药物的规范应用尚存在许多问题和挑战。本文汇集国内消化外科领域著名专家及其团队、医保专家及律师,结合各中心经验,从不同角度探讨腹部手术后治疗和康复的重要意义以及生长抑素类药物的应用策略。张太平教授精简凝练地讲解消化道瘘的发生率及其危害,指出“如何能够短时间内把瘘愈合”是主要康复目标且治疗方式主要为综合治疗。陈超武教授全面介绍临床实践中几个典型病例的诊断与治疗过程,分享其团队丰富临床经验,并提出反思性问题。李非教授从实际病例入手,重点讲解十二指肠瘘,包括经内镜逆行术后并发症引起的瘘,特别强调Stanford分型,以及不同分型的治疗方法。张群女士解读国家医保政策,强调医保基金监管的重要性,分享医疗机构自主管理的相关问题。李洪奇律师从政策导向、实践案例等方面,就合理用药全面提出建议。
Abstract:Abdominal surgery as a common type of clinical surgery, postoperative treat-ment and rehabilitation has always been the focus of surgeons. Somatostatin drugs are commonly used for postoperative bleeding, portal hypertension bleeding, and prophylactic treatment of com-plications such as acute pancreatitis. However, the standardized application of somatostatin still faces numerous challenges in clinical practice. The famous experts and their teams in the field of digestive surgery, medical insurance expert and lawyer, combined with the experience of their respective centers, under the new national medical insurance policy, explore the significance of treatment and rehabilitation after abdominal surgery and the application strategy of somatostatin drugs from different angles. Professor Zhang Taiping succinctly explained the incidence and harm of gastro-intestinal fistula, pointing out that "how to heal the fistula in a short time" is the main rehabilitation goal and the treatment is mainly comprehensive treatment. Professor Chen Chaowu comprehen-sively introduces diagnostic and treatment processes for several representative cases encountered in clinical practice while sharing his team′s rich clinical experience and posing reflective questions. Professor Li Fei starts with practical cases, focusing on duodenal fistula, including fistula caused by complications after endoscopic retrograde cholangiopancreatography, with special emphasis on Stanford classification and different types of treatment. Ms. Zhang Qun interprets national medical insurance policies. She emphasizes the significance of supervising medical insurance funds and shares experiences related to issues regarding autonomous management by healthcare institutions. Lawyer Li Hongqi provides comprehensive suggestions on rational use of drug based on policy guidance and practical cases.
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感谢董家鸿院士、曹晖教授、陈敏教授、陈鸣宇教授、陈汝福教授、陈亚进教授、崔云甫教授、董明教授、樊林教授、何宇教授、郭庆渠教授、胡彦锋教授、李勇教授、李元新教授、卢倩教授、秦仁义教授、沈柏用教授、盛基尧教授、项灿宏教授、姚宏伟教授、殷晓煜教授、余德才教授对该热点对话的指导和参与。所有作者均声明不存在利益冲突张太平, 陈超武, 李非, 等. 腹部手术生长抑素类药物规范应用的研究进展[J]. 中华消化外科杂志, 2024, 23(5): 676-679. DOI: 10.3760/cma.j.cn115610-20240506-00235.
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[1] FalconiM, PederzoliP. The relevance of gastrointestinal fistulae in clinical practice: a review[J]. Gut,2001,49(Suppl 4):iv2‑iv10. DOI: 10.1136/gut.49.suppl_4.iv2.
[2] 李锐.消化道瘘内镜处理[J].内科急危重症杂志,2018,24(1):1‑3. DOI: 10.11768/nkjwzzzz20180101. [3] CorletoVD. Somatostatin and the gastrointestinal tract[J]. Curr Opin Endocrinol Diabetes Obes,2010,17(1):63‑68. DOI: 10.1097/MED.0b013e32833463ed.
[4] StevensP, FoulkesRE, Hartford‑BeynonJS, et al. Systema-tic review and meta‑analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula[J]. Eur J Gastroenterol Hepatol,2011,23(10):912‑922. DOI: 10.1097/MEG.0b013e32834a345d.
[5] LeandrosE, AntonakisPT, AlbanopoulosK, et al. Somatos-tatin versus octreotide in the treatment of patients with gas-trointestinal and pancreatic fistulas[J]. Can J Gastroenterol,2004, 18(5):303‑306. DOI: 10.1155/2004/901570.
[6] CaoZ, QiuJ, GuoJ, et al. A randomised, multicentre trial of somatostatin to prevent clinically relevant postoperative pancreatic fistula in intermediate‑risk patients after pancreaticoduodenectomy[J]. J Gastroenterol,2021,56(10):938-948. DOI: 10.1007/s00535-021-01818-8.
[7] 国家医疗保障局.2023年国家基本医疗保险、工伤保险和生育保险药品目录调整工作方案[EB/OL].(2023-06-29)[2024-05-06]. http://www.nhsa.gov.cn/art/2023/6/29/art_109_10921.html. [8] HarrisAG. Somatostatin and somatostatin analogues: phar-macokinetics and pharmacodynamic effects[J]. Gut,1994,35(3 Suppl):S1‑S4. DOI: 10.1136/gut.35.3_suppl.s1.
[9] ShulkesA. Somatostatin: physiology and clinical applications[J]. Baillieres Clin Endocrinol Metab,1994,8(1):215-236. DOI: 10.1016/s0950-351x(05)80232-0.
[10] Van Op den Bosch J, AdriaensenD, Van NassauwL, et al. The role(s) of somatostatin, structurally related peptides and somatostatin receptors in the gastrointestinal tract: a review[J]. Regul Pept,2009,156(1‑3):1‑8. DOI: 10.1016/j.regpep.2009.04.003.
[11] PatelYC, GreenwoodMT, WarszynskaA, et al. All five cloned human somatostatin receptors (hSSTR1‑5) are functiona-lly coupled to adenylyl cyclase[J]. Biochem Biophys Res Commun,1994,198(2):605‑612. DOI: 10.1006/bbrc.1994.1088.
[12] NeubigRR, SpeddingM, KenakinT, et al. International Union of Pharmacology Committee on Receptor Nomenclature and Drug Classification. XXXVIII. Update on terms and sym-bols in quantitative pharmacology[J]. Pharmacol Rev,2003,55(4):597‑606. DOI: 10.1124/pr.55.4.4.
[13] MERCK.注射用生长抑素说明书[EB/OL].[2021‑09‑19]. https://www.hastenpharma.com/upload/2023-05/1683 88364584835600.pdf. [14] KumpfVJ, de Aguilar‑NascimentoJE, Diaz‑PizarroGraf JI, et al. ASPEN‑FELANPE clinical guidelines[J]. JPEN J Parenter Enteral Nutr,2017,41(1):104‑112. DOI:10.1177/0148607 116680792.
[15] 中华医学会外科学分会胃肠外科学组,中华医学会外科学分会腹腔镜与内镜外科学组,中国抗癌协会胃癌专业委员会.完全腹腔镜胃癌手术消化道重建专家共识及手术操作指南(2018版)[J].中国实用外科杂志,2018,38(8):833‑839. DOI: 10.19538/j.cjps.issn1005-2208.2018.08.01. [16] 中国医师协会外科学分会肠瘘外科医师委员会.中国克罗恩病并发肠瘘诊治的专家共识意见[J].中华胃肠外科杂志,2018,21(12):1337‑1346. DOI: 10.3760/cma.j.issn.1671-0274.2018.12.002. [17] SobockiJ, JackowskiM, DzikiA, et al. Clinical guidelines for the management of gastrointestinal fistula‑developed by experts of the Polish Surgical Society[J]. Pol Przegl Chir,2021,93(4):57‑69.
[18] 胡石奇,刘振邦,陈熙文,等.生长抑素对腹部手术后早期肠内营养支持影响的临床观察[J].中华肝胆外科杂志,2010,16(4):266‑269. DOI:10.3760/cma.j.issn.1007-8118. 2010. 04.009. [19] 中华医学会消化内镜学分会ERCP学组,中国医师协会内镜医师分会,北京医学会消化内镜学分会.中国胆瘘消化内镜诊治专家共识(2020,北京)[J].中华消化内镜杂志,2021,38(3):186‑194. DOI:10.3760/cma.j.cn321463-20201208-00 951. [20] 中华医学会外科学分会胰腺外科学组,中国研究型医院学会胰腺疾病专业委员会,中华外科杂志编辑部.胰腺术后外科常见并发症防治指南(2022)[J].中华外科杂志,2023,61(7):e1‑e18. DOI: 10.3760/cma.j.cn112139-20230419-00173. [21] AlkhateebHM, AljanabiTJ, Al‑AzzawiKH, et al. Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy[J]. Int J Surg Case Rep,2015,16:7‑11. DOI: 10.1016/j.ijscr.2015.08.039.
[22] 刘亮,徐志航,王文权,等.精准联合综合策略防治胰十二指肠切除术后胰瘘[J].中华消化外科杂志,2023,22(5):657-662. DOI: 10.3760/cma.j.cn115610-20230401-00143. [23] LiJ, WangR, TangC. Somatostatin and octreotide on the treatment of acute pancreatitis‑basic and clinical studies for three decades[J]. Curr Pharm Des,2011,17(16):1594-1601. DOI: 10.2174/138161211796196936.
[24] 国家医疗保障局.基本医疗保险用药管理暂行办法[EB/OL].(2020‑07‑31)[2024-05-06]. http://www.nhsa.gov.cn/art/2020/7/31/art_37_3387.html. [25] 全国人民代表大会.中华人民共和国医师法[EB/OL].(2021-08‑20)[2024-05-06]. http://www.npc.gov.cn/npc/c2/c30 834/202108/t20210820_313104.html.
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