食管癌手术加速康复策略麻醉专家共识

Expert consensus on anesthesia in Enhanced Recovery after Surgery for esophageal cancer surgery

食管癌根治术涉及多个手术野的外科切除及消化道重建,其并发症和死亡率均较高,对患者的术后康复提出了挑战。近年来,加速康复外科(ERAS)作为一种新兴的医学理念,已逐渐被医务人员接受并广泛应用,其在食管癌外科治疗中也取得了显著疗效。本文总结了围手术期食管癌ERAS治疗中具有循证医学证据的措施,并形成了一套贯穿围手术期的食管癌ERAS治疗临床路径,以期为临床实践提供帮助。术前阶段倡导术前宣教、术前营养和风险评估与准备,个体化禁食禁水,选择最佳的新辅助治疗后的手术时机,建立多学科团队(MDT)联合诊疗模式;术中优化麻醉策略,维持最佳液体平衡,行保护性肺通气策略,避免术中低体温和选择合适的手术方式;术后应充分镇痛,预防血栓形成,尽早恢复活动,早期拔除鼻胃管、引流管和尿管,预防术后并发症,积极行肠内营养。当然,ERAS方案不是一成不变的,其仍在持续改进中并逐步进行系统培训和推广,以期在更多医疗中心推广应用。

Esophageal cancer is one of the common malignant tumors of the digestive system in China.Surgical intervention is a frequently employed method for treating esophageal cancer.However,esophagectomy is a complex surgical procedure with a relatively high incidence of complications and mortality.In recent years,enhanced recovery after surgery(ERAS)as a novel medical concept,has gradually gained acceptance among healthcare professionals and been widely applied.It has also demonstrated significant efficacy in the surgical treatment of esophageal cancer.This article summarizes evidence-based medicine(EMB)in the perioperative period of ERAS for esophageal cancer treatment and formulates a clinical pathway for ERAS in esophageal cancer treatment throughout the perioperative period,aiming to provide guidance for clinical practice.Preoperatively,the following measures are advocated:preoperative education,preoperative nutrition assessment and risk assessment,individualized fasting and fluid restriction,optimal timing of surgery after neoadjuvant therapy,and the establishment of a multidisciplinary team(MDT)collaborative diagnostic and treatment model.Intraoperatively,optimization of anesthesia strategies,maintenance of optimal fluid balance,implementation of protective lung ventilation strategies,prevention of intraoperative hypothermia,and the selection of appropriate surgical techniques are essential.Postoperatively,effective pain management,thrombosis prevention,early mobilization,early removal of nasogastric tubes,drainage tubes,and urinary catheters,prevention of postoperative complications,and proactive enteral nutrition should be emphasized.It is important to note that the ERAS protocol is not static and continues to undergo improvement,with ongoing systematic training and promotion in the hope of wider adoption in more medical centers.