中国普外基础与临床杂志

中国普外基础与临床杂志

快速康复外科应用于肝胆管结石的现状及展望

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目的 总结快速康复外科(ERAS)的内容并了解其应用于肝胆管结石的现状及展望。 方法 复习近年来国内外关于 ERAS 的描述并综述其在肝胆管结石中的应用情况。 结果 ERAS 的主要内容包括术前宣教、营养管理及胃肠道管理,术中的微创手术方式、合理的麻醉方式选择、术中输液量管理、维持术中的体温恒定、镇痛及预防术后恶心呕吐用药方案的选择,术后的早期进食、早期锻炼、早期拔管、目标导向液体治疗以及多模式镇痛方案的应用及 T 管的管理、合理的出院标准及随访管理。虽然 ERAS 在肝胆管结石病患者中应用报道较少,从现有的文献报道来看,应用于肝胆管结石病仍具有独特的优势,在促进患者康复、提高患者满意度等方面取得良好疗效,也是安全、有效的。 结论 ERAS 理念应用于肝胆管结石病患者,实现了患者围手术期的精细化管理和个体化治疗,能取得良好的短期治疗效果,优化了医疗管理模式。但是现阶段在肝胆管结石病患者中执行和推广仍存在缺乏方案设计标准与规范、循证医学依据等问题,需要进一步加强多学科团队之间的交流与协作,使 ERAS 方案进一步完善并推广。

Objective To summarize contents of enhanced recovery after surgery (ERAS) and understand it’s status and prospect in application of patients with hepatolithiasis. Methods The descriptions of ERAS in recent years and applications in hepatolithiasis were reviewed. Results The ERAS programme mainly included the preoperative managements, such as the education, nutrition management, and gastrointestinal tract management; the intraoperative managements, such as the minimally invasive surgery, reasonable choice of anesthesia, infusion volume management, and maintenance of body temperature, analgesia, and preventing postoperative nausea and vomiting medication selection; the postoperative early feeding, early exercise, early extubation, multimodal analgesia, T tube management, reasonable discharge standard and follow-up management. Although the ERAS was rarely reported in patients with hepatolithiasis, it had some advantages of promoting recovery and improving patient satisfaction, and it was still effective and safe. Conclusions Application of ERAS concept in patients with hepatolithiasis has achieved precision management and individualized treatment during perioperative period. It could achieve a good short-term therapeutic effect and optimize medical management model. However, there are still some problems at the present stage in implementation and promotion of patients with hepatolithiasis, such as lacks of criteria and specifications, evidence-based medicine. It is needed to further strengthen communication and collaboration among multiple disciplinary teams so as to further improve ERAS programme and popularize it.

关键词: 肝胆管结石; 快速康复外科

Key words: hepatolithiasis; enhanced recovery after surgery

引用本文: 张心怡, 熊先泽, 程南生. 快速康复外科应用于肝胆管结石的现状及展望. 中国普外基础与临床杂志, 2018, 25(3): 372-378. doi: 10.7507/1007-9424.201710034 复制

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