加速康复外科在胰十二指肠切除术中的应用

Abstract

加速康复外科(enhanced recovery after surgery, ERAS)已在全球范围内实施，有强有力的证据表明，遵守ERAS方案可以减少围术期应激反应及医疗并发症、费用，缩短住院时间，促进病人康复。而胰十二指肠切除术(PD)作为普通外科较为复杂的手术之一，存在术后有较高的并发症发生率及死亡率等问题，患者术后生存质量及远期疗效也不理想，ERAS理念及路径在胰腺外科领域应用不多，相关研究的数量与质量均很有限，导致临床对在胰十二指肠切除术中开展加速康复外科的认可度、接受度特别是对于是否行术前营养支持、术后鼻胃管和腹腔引流管拔除时机，术后生长抑素使用与否等几个关键问题存在较大争议，使得一小部分患者在胰十二指肠切除术后未能从ERAS项目中获益。本文针对PD特点，从术前干预、术中和术后管理三个层面详细阐述ERAS在PD的应用进展。 Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs, hospital stay and promotes patient. Pancreaticoduodenectomy (PD), as one of the more complicated general surgery procedures, has problems such as high postoperative complications and mortality, and the quality of life and long-term efficacy of patients are not ideal. , ERAS concept and path are not widely applied in the field of pancreatic surgery, and the quantity and quality of related research are very limited, which leads to clinical recognition and acceptance of accelerated rehabilitation surgery in pancreaticoduodenectomy, especially whether it is feasible or not. Several key issues such as preoperative nutritional support, postoperative nasogastric tube and abdominal drainage tube removal timing, and postoperative somatostatin use are controversial, making a small number of patients fail after pancreaticoduodenectomy. Can benefit from the ERAS project. According to the characteristics of PD, this article elaborates on the application progress of ERAS in PD from three levels of preoperative intervention, intraoperative and postoperative management.