快速康复在结直肠手术中的应用

Fast-track colorectal surgery

近年来,快速康复外科(fast-track surgery,FTS)引起了越来越多人的重视.然而多数人对其应用于结直肠手术的安全性及有效性心存顾虑.本文综述了FTS主要组成部分(不常规行机械肠道准备,硬膜外麻醉及镇痛,腹腔镜手术,早期移除鼻胃减压管、引流管,术后早期进食)对择期行结直肠手术的患者的术后并发症发生率的影响.同时对FTS的有效性(缩短住院日,加速康复,降低胰岛素抵抗,保护机体免疫功能)也进行了详细的论述.另外,我们还总结了FTS实施过程中遇到的困难.最后,我们得出这样的结论:FTS应用于结直肠手术是安全有效的,并且应该被广泛推广.

In recent years,fast-track surgery has been attracting more and more attention;however, many people remain concerned about the safety and effectiveness of fast-track colorectal surgery.In this paper we discuss how the main components of fast-track colorectal surgery（no routine mechanical bowel preparation,epidural anaesthesia or analgesia,laparoscopic operation, early removal of nasogastric tube and drainage tube,early postoperative oral feeding）affect the incidence of postoperative complications.Meanwhile,we evaluate the effectiveness of fast-track colorectal surgery in terms of shortened length of hospital stay,facilitated recovery,reduced insulin resistance,and better preserved immune function.Besides,we summarize the difficulties confronted during the implementation of fasttrack colorectal surgery.We conclude that fasttrack colorectal surgery is a safe and effective approach that deserves to be popularized in clinical practice.