胃癌术前评估与术后并发症高危因素

Preoperative evaluation of gastric cancer and risk factors for postoperative complications

外科手术是治愈胃癌的关键。安全实施胃癌根治术离不开充分的术前评估、精细的术中操作和严密的术后管理。充分的术前评估旨在确定病期、识别潜在可能导致术后并发症的高危因素(包括患者高龄、美国麻醉医师协会评分、体质指数、术前合并疾病和低蛋白血症等术前状态因素;术中出血量和联合脏器切除等术中操作相关因素),并通过预康复等手段优化患者身体机能状态,以利于术者制定合理的外科治疗决策,以促进患者术后顺利康复。在加速康复外科理念的广泛普及和应用下,旨在优化术前心肺功能和骨骼肌功能的预康复干预越来越受到关注。尽管有随机对照研究显示了预康复措施的有效性,但学界仍需在预康复的具体措施、有效评估指标、适应人群和干预时间等问题上达成共识。兼顾效率和安全,才能更好地推动术前评估举措在胃癌临床实践中应用实施。

Surgical resection plays pivotal role in the treatment of gastric cancer.Adequate preoperative evaluation,precise intraoperative maneuver and delicate postoperative management lay the foundation for successful gastrectomy.The aim of preoperative evaluation is to stage tumor and identify potential risk factors(including preoperative factors like age,ASA status,body mass index,comorbidity,hypoalbuminemia,and intraoperative factors like blood loss and combined resection)which could lead to postoperative complication.With the management of prehabilitation,adequate medical decision could be made and patient's fast recovery could be ensured.With the rapid adoption of ERAS concept,there is increasing attention to prehabilitation which focus on optimization of cardio-pulmonary capacity and muscular-skeletal capacity.Despite of the efficacy of prehabilitation demonstrated by randomized controlled trials,consensus has yet to be reached on the following items:specific intervention,optimal measurement,candidate population and optimal timing for intervention.Balancing the efficiency and safety,preoperative evaluation could be put into clinical practice smoothly.