加速康复外科在妇科恶性肿瘤手术中的应用

The application of enhanced recovery after surgery in gynecological malignant tumor surgery

加速康复外科是指在围手术期采用一系列经循证医学证实有效的优化措施,以减少围手术期应激并加快手术患者术后恢复的理念。由于妇科恶性肿瘤手术创面大、手术并发症多,住院治疗费用高,患者身心都会受到一定的影响。目前国内外有大量研究报道ERAS理念在妇科恶性肿瘤围手术期管理措施中的应用,结果显示加速康复理念的引入,能够在达到治疗效果的同时使患者更快地恢复,更快地进入后续的放化疗阶段,同时减少并发症,缩短住院时间从而减低医疗费用。因此,在术后恢复学会更新发布的妇产科/肿瘤科围术期管理指南基础上,本文结合文献就术前禁食水的时间、肠道准备、腹腔镜手术、术后镇痛及围术期营养对患者术后康复的影响进行综述。

Enhanced recovery after surgery refers to the concept of using a series of effective optimization measures proved by evidence-based medicine to reduce perioperative emergency and accelerate postoperative recovery.The physical and psychological health of patients will be affected to a certain extent,due to the large surgical wounds and complications of gynecological malignant tumor surgery,and the cost of hospitalization is high.At present,there have been a large number of studies at home and abroad that demonstrate the application of ERAS concept in the perioperative management of gynecological malignant tumors.The results show that the introduction of ERAS concept can ensure to achieve the same therapeutic effect,and make the patients recover faster and enter the following stage of radiotherapy and chemotherapy more quickly.It can also reduce complications,shorten recovery time and reduce medical cost subsequently.Therefore,based on the updated guidelines for perioperative management of obstetrics and gynecology/oncology issued by the Society for Postoperative Recovery,this article reviews the effects of preoperative fasting time,intestinal preparation,laparoscopic surgery,postoperative analgesia and perioperative nutrition on postoperative rehabilitation.