老年结直肠癌患者手术和围手术期加速康复及术后辅助化疗的一体化管理

Integrative management of operation, perioperative rehabilitation and postoperative adjuvant chemotherapy in elderly patients with colorectal carcinoma

随着我国逐渐步入老龄化社会．老年结直肠癌患者逐渐增多。但针对这一特殊人群结直肠癌的治疗可以遵循的循证医学依据并不多。由此，浙江大学医学院附属二院大肠癌诊治中心提出了老年结直肠癌患者手术、围手术期康复与辅助治疗的“一体化管理”理念，即让整个治疗进程作为一个整体进行协调运作，各专科部门之间相互协作、相互补充并相互强化，最终形成强大的合力，从而实现最大化和最优化的治疗效果。实现一体化管理的具体方案为“横向一体化”和“纵向一体化”。“横向一体化”是指各治疗部门之间的协同，尤其是各临床专科之间的协作治疗和医护之间的协调配合，即多学科综合治疗模式（MDT）；“纵向一体化”即治疗进程前后目标一致性、分工协调性以及严格完成性，缺一不可，即临床路径。本文还着重介绍了该诊治中心多年来施行“一体化管理”的策略，即在实施流程中应注重临床康复指标与生化恢复指标的一体化管理和结直肠癌患者手术与术后辅助治疗的一体化管理。

With the aging of the Chinese population, it seems obvious that the number of elderly patients with the disease of colorectal carcinoma grows significantly. Meanwhile, no evidence-based practical guideline for the treatment of colorectal carcinoma are available in this particular age group. Therefore, the concept of integrative management has been brought up by the Colorectal Cancer Center of the Second Affiliated Hospital of Zhejiang University, which combines the processes of surgery, perioperative rehabilitation and adjuvant chemotherapy together. In this way, the cooperation and complementarity between different clinical departments could cooperate and complete tasks together to integrate the treatment processes into a cohesive one. To achieve the goal of integrative management, the project is divided into horizontal and vertical aspects. The horizontal integration means the cooperation between different clinical departments, which is also known as multi-discipline treatment （MDT）. The vertical integration reflects the completeness of the entire treatment under the goal of consistency, strictness and job separation, which could also be explained as the clinical pathway. Furthermore, this review stresses on the integrative strategy of both clinical and biochemical indexes rehabilitation, as well as the operation and postoperative adjuvant chemotherapy which has been put in execution several years by the Colorectal Cancer Center of the Second Affiliated Hospital of Zhejiang University.