加速康复外科理念在胃癌患者中的应用进展

Research progress in perioperative applicationof enhanced recovery after surgery for gastric cancer

加速康复外科(enhanced recovery after surgery,ERAS)是一种以循证医学证据为根据,各项学科协作参与的围术期理念。其通过ERAS协会修订的加速康复外科共识及路径管理指南对外科手术围手术期处理措施予以更新、优化,从术前术中术后各个环节减少患者的应激反应,降低围术期并发症的发生率,促进患者各脏器功能的早期恢复,从而提高手术治疗的效率与质量。近几年来,胃癌ERAS诊疗理念已在国内外得到广泛接受,相关研究结果显示了其相对于传统围术期观念的优势所在,已成为今后胃癌围术期诊治的新标准化方案。但目前国内各中心胃癌围术期处理的具体措施尚未形成统一的临床路径。新老两代医务人员有待进一步达成共识。为此,作者分析ERAS理念在胃癌患者围手术期应用的研究进展,就术前宣教、术前营养评估、术前禁食时间、术前肠道准备、手术术式、围术期疼痛管理、术后鼻胃管及腹腔引流的留置、术后早期动员及早期进食等方面提出了相关更新的理念及措施。

Enhanced Recovery After Surgery(ERAS)is a perioperative concept involving collaboration of various disciplines on the basis of evidence-based medicine.It updates and optimizes the perioperative management of surgical operation through the Enhanced Recovery after Surgery Consensus and Clinical guidelines revised by the ERAS Association,so as to reduce the stress reaction from every link before,during and after operation and reduce the incidence rate of perioperative complications,promote the early recovery of the functions of the organs,which ultimately achieve the goal of improving the efficiency and quality of surgical treatment.In recent years,the concept of Enhanced Recovery after Surgery for gastric cancer has been widely recognized both at home and abroad.Related research has shown its advantages over traditional perioperative concepts,which means ERAS has become a new standard for the perioperative diagnosis and treatment of gastric cancer in the future.However,we can't find an official clinical pathway in perioperative application of enhanced recovery after surgery for gastric cancer.Two generations of medical personnel need to reach a consensus of ERAS program.Therefore,the author analyzes the recent research advances in perioperative application of ERAS concept of gastric cancer patients will be reviewed in this article,meanwhile proposes the related latest theory and practice about the following issues:preoperative education,nutrition assessment,fasting time,bowel preparation,surgical procedures,perioperative pain management,postoperative placement of nasogastric tube and abdominal drainage,early mobilization and early feeding.