加速康复外科在胰腺手术中的应用进展

Application of enhanced recovery after surgery in pancreatic surgery

目的总结加速康复外科(ERAS)在胰腺手术中的应用现状。方法检索近年国内外有关胰腺外科领域中ERAS应用的临床研究文献,对ERAS在胰腺手术中的应用进展作一综述。结果在ERAS理念指导下,通过术前患者宣讲教育、依从性审核及良好的术前准备,术中微创化的手术方式和精密的液体管理,术后良好的疼痛管理、营养支持、血糖调节及腹腔引流管的管理,有利于实现患者的快速康复、缩短住院时间及减少住院花费。结论虽然ERAS在胰腺手术中的应用已逐渐为胰腺外科医生所接受,但仍需在大规模胰腺外科中心、多学科综合诊疗模式下保证其安全有效地推进。此外,国外指南中的部分相关指导建议多来源于其他学科实践经验,其在胰腺手术中的指导价值仍不明确,仍需要我国多中心的进一步临床研究。

Objective To explore the application of enhanced recovery after surgery in pancreatic surgery. Methods In this paper, the clinical research of ERAS in the field of pancreatic surgery in recent years were reviewed. Results Under the guidance of ERAS, preoperative patient education, compliance audit, and high quality preoperative preparation; minimally invasive surgery and precise fluid management; pain management, nutrition support, blood glucose regulation, and peritoneal drainage management, could be beneficial for patients to recover rapidly, shorten the hospitalization time, and reduce the hospitalization cost. Conclusions Although the application of ERAS in pancreatic surgery has been gradually accepted by the pancreas surgeon, but it still need to ensure its safety and effectiveness in the high volume pancreatic surgery center with multidisciplinary treatment. In addition, some of the recommendations in foreign guidelines are mostly cited from other disciplines of practical experience, its guiding value in pancreatic surgery is still unclear, and still needs more multicenter clinical research.