广东省炎症性肠病围手术期加速康复外科管理专家指导意见

Experts consensus on the mangement of enhanced recovery after surgery of Guangdong province in inflammatory bowel disease perioperative care

有相当比例的炎症性肠病(IBD)患者会在其自然病程中出现肠道狭窄、梗阻、穿孔、消化道瘘、出血、癌变等需要外科手术干预的并发症,除少部分IBD患者因并发急性消化道穿孔、大出血或严重肠梗阻需急诊手术外,其余大部分患者可以通过药物优化、肠内或肠外营养支持、腹腔脓肿穿刺引流等治疗措施改善营养状态、控制炎症反应后行择期手术。对于加速康复外科(ERAS)能否安全地应用于IBD患者,目前未见相关共识或指南。因此,广东省医学会加速康复外科学分会组织相关学科的专家经讨论提供本指导意见,以进一步规范ERAS路径在IBD围手术期管理中的应用。

A considerable proportion of patients with inflammatory bowel disease(IBD)will have complications requiring surgical intervention such as intestinal stricture,obstruction,perforation,fistula,bleeding,and carcinogenesis in their natural disease course.Except for a small number of IBD patients who require emergency surgery due to acute gastrointestinal perforation,massive bleeding or severe intestinal obstruction,most of the remaining patients can improve their nutritional status and control the inflammatory response by prehabilitation including enteral/parenteral nutrition support,percutaneous abscess drainage before elective surgery.There is no consensus or guideline on whether enhanced recovery after surgery(ERAS)can be used safely in patients with IBD.Therefore,the ERAS Branch of Guangdong Medical Association organized related experts to formulate this consensus,aiming to standardize the application of ERAS pathways in the perioperative management of IBD.