中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

胰十二指肠切除术围手术期实施加速康复共识与争议

蒋奎荣，陆子鹏，苗    毅   

  1. 南京医科大学第一附属医院胰腺中心，江苏南京210029
  • 出版日期:2016-08-01 发布日期:2016-07-27

  • Online:2016-08-01 Published:2016-07-27

摘要：

胰十二指肠切除术（PD）手术范围大，风险高，围手术期管理难度大。目前，加速康复外科（ERAS）理念已获得国内大部分外科医生的认可，但围绕其实施和应用仍然存在诸多争议和质疑，在PD围手术期处理中尤为如此。国内外的临床证据显示，PD实施ERAS总体安全有效，对于部分争议较大的ERAS措施也存在较强的临床证据支持其应用。因此，建议在循证医学理念指导下系统开展ERAS，对于存在争议的ERAS措施，应做到积极应对、有序探索、谨慎尝试，在保证病人安全的前提下进行ERAS临床实践，并建立更多临床证据，最终使病人受益。

关键词: 胰十二指肠切除术, 加速康复外科, 围手术期

Abstract:

The consensus and controversy in the application of ERAS in pancreaticoduodenectomy        JIANG Kui-rong，LU Zi-peng，MIAO Yi. Pancreas Center, the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding author:MIAO Yi, E-mail: miaoyi@njmu.edu.cn
Abstract    Pancreaticoduodenectomy (PD) is ultramajor procedure with high risk of complications，it is difficult to carry out perioperative management. Currently, the concept of enhanced recovery after surgery (ERAS) has been accepted by most of surgeons in China，and ERAS management has been more and more implemented in hospitals in different areas in China. However, controversies and debates remained in the implementation during ERAS practice，especially in ERAS for PD. Clinical evidence from international and domestic institute all showed that the application of ERAS in PD is safe and effective, and moderate-strong evidence exist in the utilizing of the “controversial” ERAS measures. We should apply ERAS under the guidance of evidence-based medicine. For ERAS measures with no or low-level evidence or in conflict with the traditional surgery practice，we should act positively，explore with plan，and test in clinical cautiously. Under the premise of ensuring patient safety，we should get more clinical evidence for ERAS application，in order to benefit the patients ultimately.

Key words: pancreaticoduodenectomy, enhanced recovery after surgery, perioperative period