ERAS在结直肠肿瘤中的应用及其进展

Implementation and research progress of ERAS in colorectal cancer

结直肠癌是世界范围内最常见的肿瘤致死原因之一,现在仍然是手术切除为主。手术分级一般为三级、四级手术,常需要全身麻醉,且手术范围大,对患者创伤打击大,导致术后恢复慢且延长了住院时间。近几年来,人们对医疗安全意识的不断增强,对临床疾病的治疗效果的要求也越来越高,促使医疗机构不断提高医疗水平,从而改善疾病治疗的不良结局。加速康复外科(ERAS)是整合了一系列优化的围手术期处理措施,其目标是通过减轻围手术期的各种应激反应,改善器官功能紊乱,加快患者术后康复。ERAS应用于结直肠外科,能够在不增加再次入院次数的前提下,缩短住院时长和减少术后并发症的发生。近年来,基于ERAS理念的干预措施取得令人满意的效果,在国内外得到了快速发展和应用。然而,ERAS需要多学科协作以及患者和家属的积极参与,目前在国内的推广还很缓慢。随着结直肠手术技术的快速发展以及医疗付费体制的改革,为ERAS理念在结直肠领域的进一步推广和应用提供了更多有力的支持。

Colorectal cancer is one of the most common causes of cancer deaths worldwide.And nowadays surgery is still the preferred treatment for it.Colorectal surgery is usually classed as gradeⅢorⅣsurgery according to the surgical classification.It often requires general anesthesia,and the scope of operation is larger and the duration of operation is longer,which has a great impact on the trauma of patients,leading to slow postoperative recovery and prolonged hospital stay.In recent years,people′s awareness of medical safety is constantly enhanced,and the requirements for the treatment effect of clinical diseases are also increasingly high,prompting medical institutions to constantly improve the level of medical treatment,so as to improve the adverse outcome of disease treatment.Enhanced recovery after surgery(ERAS)protocols integrate a series of optimized perioperative management measures,aiming at alleviating various perioperative stress responses,improving organ dysfunction and speeding up postoperative recovery of patients.Benefits of ERAS implementation in colorectal surgery include reduced length of stay and decreased complications without an increase in readmissions.In recent years,the concept of ERAS has been rapidly developed and applied at home and abroad.Intervention measures based on the concept of ERAS can achieve satisfactory application effects.However,ERAS requires multidisciplinary collaboration and the active participation of patients and their families,and its introduction in China has been slow.However,the rapid development of colorectal surgery technology and the reform of medical payment system provide more favorable support for the further promotion and application of ERAS concept in the field of colorectal.