中国老年结直肠肿瘤患者围手术期管理专家共识(2020版)

Expert consensus on perioperative management of elderly patients with colorectal cancer in China(2020 Edition)

结直肠肿瘤是高发恶性肿瘤,其发病率随年龄增长而逐渐增高。从全世界范围来看,每年50%新增结直肠肿瘤患者均为70岁以上老年患者,其中25%是80岁以上高龄患者。老年患者术前多有合并症,因而围手术期风险更高。此外,老年患者通常伴有更晚期的局部肿瘤病灶,其在就诊时往往已发生肠道梗阻或病变转移,导致手术操作难度加大。现已明确,高龄是增加围手术期病死率的独立危险因素。因此,为了更好地应对老年肿瘤患者围术期管理挑战,由中国医师协会结直肠肿瘤专业委员会围术期医学专委会的相关专家制定老年结直肠肿瘤患者围术期管理专家共识,从术前、术中和术后三个不同围术期阶段入手,围绕老年结直肠肿瘤患者术前综合评估、预康复措施、肺保护性通气策略、目标导向液体治疗、区域阻滞镇痛管理、术后认知功能障碍防治等重点问题进行探讨,以进一步提高老年结直肠肿瘤患者围术期管理水平,加速患者术后康复,改善患者预后。

Colorectal cancer is a malignancy with high incidence,and its incidence increases with age.Each year 50%of new colorectal cancer patients are over 70 years old worldwide,and 25%of new colorectal cancer patients are over 80 years old.Preoperatively,elderly patients are more likely to have complications and thus have a higher perioperative risk.In addition,elderly patients are often accompanied with more advanced local tumor lesions,which frequently caused intestinal obstruction or lesion metastasis at the time of consultation,resulting in more difficult surgeries.It has been established that advanced age is an independent risk factor for increased perioperative mortality and mobility.Therefore,in order to cope better with the challenges of perioperative management of elderly colorectal cancer patients,this expert consensus on perioperative management of elderly patients with colorectal cancer is developed by the experts of the Perioperative Medicine Special Committee of the Chinese Society of Colorectal Cancer.And this expert consensus included preoperative,intraoperative and postoperative stages of perioperative periods.And comprehensive preoperative evaluations in elderly colorectal cancer patients,rehabilitation measures,lung protective ventilation strategy,goal-directed fluid therapy,regional analgesia management and prevention and treatment of postoperative cognitive dysfunction are all discussed in this expert consensus.Therefore,this expert consensus further improves the perioperative management level of elderly colorectal cancer patients,speeds up postoperative rehabilitation and improves the prognosis of elderly colorectal cancer patients.