胃肠手术围手术期处理理念的更新与完善

Recent progress in the perioperative management in gastrointestinal surgery

胃肠外科手术在近半世纪以来发展迅速．尤其微创外科技术的发展更是使胃肠外科进入到了一个新纪元。围手术期的处理在“损伤控制外科”和“加速康复外科”理念的指导下．得到进一步重视和完善。正确诊断和营养状况评估等术前良好的准备．是保证手术成功的主要条件之一。手术者在掌握多种技术的前提下，根据患者的条件，选择相应的技术和手术器械。是减少手术对患者组织创伤和手术后遗症的重要保障。术后镇痛利于患者早期离床活动以恢复体力，防止心、肺等脏器并发症的发生；术后早期进食可促进肠功能的恢复，保护肠屏障功能，防止肠道菌群紊乱的发生：有利于患者的康复。

The last half century has witnessed a rapid progress in gastrointestinal surgery, and the development of minimally invasive technique has boosted gastrointestinal surgery, into a new era. The concept of perioperative management becomes more comprehensive by the introduction of damage control surgery and early recovery after surgery （ERAS）. One of the most prerequisite for successful operation is the correct diagnosis and accurate assessment and correction of malnutrition. A real mastery and proper selection of operative techniques and instruments based on the patients＇ preoperative condition could reduce tissue damage and postoperative complications. Postoperative analgesia facilitates early mobilization and recovery of patients, and may reduce posoperative cardiopulmonary complications. Early enteral feeding could promote recovery of gastrointestinal function, protect gastrointestinal barrier, prevent dysbiosis of gut flora, thus facilitate patients＇ recovery.