胰十二指肠切除围手术期加速康复值得重视的若干热点问题
On some crucial issues in the perioperative practice of enhanced recovery after surgery(ERAS)for pancreaticoduodenectomy
胡浩 1杨尹默2
作者信息
- 1. 北京大学第一医院肝胆胰外科,北京 100034;航天中心医院肝胆外科,北京 100049
- 2. 北京大学第一医院肝胆胰外科,北京 100034
- 折叠
摘要
近年来加速康复理念及路径在腹部外科已有广泛应用.胰十二指肠切除术作为腹部外科的代表性术式,具有操作复杂、手术时间长、并发症多、术后恢复慢等临床特点,加速康复理念及路径在其围手术期中的应用相对迟缓滞后,除预康复、液体治疗、营养支持、多模式镇痛等共性问题外,针对胰腺外科的特殊性问题如术后胃肠减压及腹腔引流管留置与否及留置时间、术后饮食管理等,尽管国内外已有较高质量研究证明加速康复理念及路径的安全性,但在临床实践中依从性有限,执行过程中存在争议,尤其是在目前微创外科理念及技术得以较为广泛应用的大背景下,如何在保障安全性的前提下,最大限度联合微创、加速康复的潜能与优势,兼顾大外科围手术期处理的一般性原则与胰腺外科具体问题的特殊性,使患者最大获益,极具临床意义.本文讨论近年来加速康复外科理念及路径在胰十二指肠切除术围手术期应用的现状与进展,以促进其更为规范、合理地应用.
Abstract
In recent years,the concept and pathways of enhanced recovery after surgery(ERAS)have been extensively applied in abdominal surgery.Pancreaticoduodenectomy(PD),as a major surgical procedure,is characterized by its complexity,prolonged operative time,high complication rate,and slow postoperative recovery.The adoption of ERAS principles and pathways in the perioperative management of PD has been relatively delayed.In addition to general concerns such as prehabilitation,fluid management,nutritional support,and multimodal analgesia,some specific issues unique to pancreatic surgery,including the necessity and duration of postoperative gastrointestinal decompression and abdominal drainage,as well as postoperative dietary management,is what really demanding special consideration.Although high-quality studies,both domestic and international,have demonstrated the safety of ERAS,its adherence in clinical practice remains limited,and controversies regarding their implementation persist.Particularly in the context of the widespread adoption of minimally invasive surgery,it is imperative to explore strategies that maximize the advantages of minimally invasive surgery and ERAS,while balancing the general principles of perioperative management with the considerations specific to pancreatic surgery,thereby optimizing patient outcomes.This review provides an overview of the current status and recent advances in the application of ERAS during the perioperative period of PD,with the aim of promoting their standardized and rational implementation.
关键词
胰十二指肠切除术/加速康复外科/围手术期管理Key words
Pancreaticoduodenectomy/Enhanced recovery after surgery/Perioperative management引用本文复制引用
出版年
2024
NETL
NSTL
万方数据