加速康复外科在胃癌手术中的应用

Application of enhanced recovery after surgery in gastrectomy for gastric cancer

  • 摘要: 加速康复外科(ERAS)整合了一系列优化的围术期处理措施,其目标是通过减轻围术期的各种应激反应,减少能量损耗,改善器官功能紊乱,加快患者术后康复。它最先应用于结直肠外科领域,随后逐渐向其他外科领域拓展。对于胃癌手术,其总体的有效性和安全性已得到循证医学的初步证实,但是对于ERAS的各个详细措施,目前还存在一定的争议。2014年欧洲加速康复外科协会制订并发布《胃切除术加速康复外科指南》,为医疗单位实施ERAS提供了优化的围术期处理方案。但在临床实践中,应该注意将指南与共识中的普遍原则与患者个体的特殊性有机地结合。由于胃癌手术的复杂性和患者情况的多样性,因此需要发展个体化的ERAS。未来ERAS的发展方向,一方面需要开展更多针对ERAS中各个措施的随机对照临床试验,以得出更加明确和有力的结论;另一方面,需要重视提高患者对各项措施的依从性。

     

    Abstract: Enhanced recovery after surgery (ERAS) combines various techniques used in the care of patients undergoing elective surgery, with an aim to attenuate the surgical stress response and energy loss, improve the organ function, reduce postoperative complications and the time required for full recovery. ERAS was first applied in the colorectal surgery, and gradually expanded to other surgical areas. As for ERAS in the gastric surgery, the safety and efficacy have been proved preliminarily by evidencebased medicine. However,  there is still controversy about the individual items of the ERAS programs due to limited studies. Recent publications of the 2014 consensus guidelines for enhanced recovery after gastrectomy Enhanced Recovery After Surgery (ERAS) Society recommendations that was composed by the ERAS Society indicated the developing direction of ERAS, and also updated perioperative practice to each medical unit implementing ERAS. Meanwhile, general principles (guideline or consensus) and patients′ conditions should be combined closely into clinical practice. Since gastric cancer surgery is complex and patients′ conditions are various, further research may focus on individualized ERAS. In the further study, more highquality randomized clinical trials with singlecomponent administration in fast recovery settings need to reach more definite conclusions and recommendations. Furthermore, attentions should be paid to enhance patients′ compliance with the ERAS items.

     

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