结直肠癌加速康复外科开展项目调查

The survey of enhanced recovery after surgery projects for colorectal cancer

目的调查国内结直肠外科应用加速康复外科(enhanced recovery after surgery,ERAS)的现状并总结存在的问题。方法本研究以中国医师协会结直肠肿瘤专委会的会员为调查对象,采用在线问卷形式进行收集,所有受访者自愿参加。受访者通过链接地址进入调查问卷主页进行访问,完成问卷后保存并提交。结果共发出问卷120份,最终107位受访者完成电子问卷调查。其中73位(68.2%)常规开展ERAS,34位(31.8%)未常规开展ERAS。针对结直肠手术ERAS的11个项目中,受访者ERAS措施开展项目数量主要集中在3~7项,其中开展4项ERAS措施的受访者最多(25位,23.4%);而针对不同ERAS措施开展的调查结果显示,11项ERAS措施中仅有4项ERAS措施的开展人数超过半数。年龄>45岁的受访者更倾向于术前不进行机械性肠道准备(P<0.001)和主张术后早期经口进食(P=0.008);医院床位数>1000张的受访者更倾向于术前口服碳水化合物(P=0.012)和术后多模式镇痛(P<0.001);每年结直肠手术量>200例的受访者更倾向于实施术前口服碳水化合物(P=0.018);开展微创手术比例>50%的受访者更倾向于选择多模式镇痛(P=0.047);而肿瘤专科医院的受访者反而更加推崇缩短术后住院时间,推荐患者早期出院(P=0.014)。常规开展ERAS的医院(P<0.001)、术前口服碳水化合物(P<0.001)、术前不放置胃管(P=0.019)、术后早期饮水(P=0.012)及术后早期经口进食(P=0.038)均与更短的术后平均住院时间有关。结论我国结直肠外科领域在ERAS的应用方面尚未普及,在不同医院、不同医生之间存在差异性,仍需要不断推广。

Objective To analyze the current situation of enhanced recovery after surgery(ERAS)application in colorectal surgery in China,and summarize the existing problems.Methods After the questionnaire was developed,members of the Chinese Society of Colorectal Cancer were selected as respondents and results were collected by online questionnaire.All the respondents volunteered to visit the homepage of the questionnaire through the link address.After completing the questionnaire,they were saved and submitted.Results A total of 120 questionnaires were sent out and finally 107 respondents completed the electronic questionnaire survey.Among them,73(68.2%)routinely carried out ERAS programmes and 34(31.8%)didn’t carry out ERAS programmes.Among the 11 ERAS programmes,most surgeons carried out 3–7 ERAS programmes,among which 4 ERAS programmes was the most(25 surgeons,23.4%).The survey results for different ERAS programmes showed that only 4 out of 11 ERAS programmes had implemented more than half of the respondents.Respondents with older than 45 years old were more inclined not to undergo mechanical bowel preparation before surgery(P<0.001)and were more likely early postoperative oral intake(P=0.008),respondents with more than 1000 hospital beds were more likely to select preoperative oral carbohydrate(P=0.012)and postoperative multimodal analgesia(P<0.001),respondents with more than 200 cases of colorectal surgery per year were more inclined to take oral carbohydrate before surgery(P=0.018),and respondents whose rate of minimally invasive surgery was higher than 50%were more inclined to choose multimode analgesia(P=0.047).On the contrary,the respondents in the tumor hospitals recommended shortening the length of postoperative hospital stay and recommending early discharge(P=0.014).Hospitals that routinely performed ERAS(P<0.001),preoperative oral carbohydrate(P<0.001),without preoperative gastric tube(P=0.019),early postoperative drinking water(P=0.012),and early postoperative oral feeding(P=0.038)were associated with a shorter average postoperative hospital stay.Conclusion ERAS has not been popularized in the field of colorectal surgery in China,and there are differences between different doctors and between different hospitals,which still need to be promoted continuously.