中国甲状腺ERAS的实施和争议

Implementation of and Controversy over ERAS in Thyroid Surgery in China

加速康复外科(enhanced recovery after surgery,ERAS)理念通过围手术期各项干预措施,显著降低手术相关并发症,缩短住院时间及降低治疗费用,以促进患者快速康复。ERAS理念应用于甲状腺外科的成果就是甲状腺日间手术,目前已在国内多家医院开展实施。甲状腺ERAS理念的本质是全程科学化管理,其核心是甲状腺精细化手术。中国医学科学院肿瘤医院自2018年开展甲状腺癌ERAS研究以来,经过多学科团队协作逐步建立科学规范的管理流程,取得良好的临床效果。甲状腺ERAS的诸多理念在国内存在争议,如甲状腺术后是否放置引流管,经我研究团队证明,对于严格筛选后的患者是安全可行的,这也是国外众多循证医学已证明并在国外指南中推荐的,但在国内仍存在争议,也未被国内指南所接受。ERAS理念的实施和推广存在着诸多社会、医院和医患之间的困难,但其应用是未来甲状腺外科的发展方向,需要在共同努力和不断完善中前行。

Enhanced recovery after surgery(ERAS)significantly reduces surgical complications by taking interventions to shorten the length of stay,reduce the cost of treatment,and promote the rapid recovery of patients.The application of the ERAS concept in thyroid surgery brings about ambulatory thyroid surgery,which has been put in practice in many hospitals in China.ERAS in thyroid surgery lies in scientific management in the whole process,and delicate surgical procedure is of the essence.Since the Cancer Hospital of Chinese Academy of Medical Sciences carried out research on ERAS protocols for thyroid cancer in 2018,it has gradually established a scientific and standardized management process through multidisciplinary cooperation,and has achieved good clinical results.Some issues of ERAS in thyroid surgery are still controversial in China.For example,whether drainage tube should be placed after thyroid surgery.It has been proven that it is safe and feasible for strictly screened patients to be exempt from post-surgical drainage,which is also certified by evidence-based medicine and recommended in foreign guidelines.Difficulties in the practice and promotion of ERAS still exist due to problems in the society,hospitals,and doctor-patient relationship.However,its application directs the future of thyroid surgery,in which joint efforts is still needed.