加速康复外科时代机器人胃癌外科  

Era of enhanced recovery after surgery and roboticgastric cancer surgery

作　　者：周岩冰[1] 

机构地区：[1]青岛大学附属医院普通外科,266003

出　　处：《中华胃肠外科杂志》2017年第5期495-499,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81279449）;山东省自然科学基金（ZR2012HM046）;青岛市民生科技计划项目（14235nsh）

摘　　要：加速康复外科（ERAS）是通过术前宣教、口服碳水化合物、硬膜外或局部麻醉、术后早期肠内营养、术后早期活动及多模式镇痛等一系列优化措施为基础的围手术期处理方案。ERAS的核心内容是降低或逆转手术应激反应，以达到改善患者临床结局的目的。机器人胃癌手术的围手术期处理也应遵循ERAS的基本原则和临床路径，将机器人胃癌根治术的优势放大。从而降低外科应激、缩短住院时间、改善生活质量。其机制与ERAS方案减轻炎性反应和胰岛素抵抗、降低静息能量消化及保护线粒体功能有关。对于机器人胃癌手术，应充分理解其围手术期病理生理学改变．严格执行经过循证医学优化的ERAS路径，倡导多学科团队密切合作，动态观察和处理术后并发症。今后需要定期审视和完善ERAS处理方案对患者临床结局所造成的影响，并根据国际规范对新的干预措施进行评价。Enhanced recovery after surgery （ERAS） has been rapidly developing by combining several techniques with evidence-based adjustments, including preoperative education, preoperative carbohydrate loading, epidural or regional anesthesia, early initiation of enteral nutrition, ambulation and multi-modal pain management. The core partof ERAS is to reduce and reverse surgical stress and therefore greatly improve clinical outcome. Under the guidance of ERAS, perioperative management of robotic gastric cancer operation should follow the basic principles of ERAS and clinical pathway to maximize the advantages of the robotic surgery. ERAS protocol is safe and feasible for patients undergoing robotic radical gastrectomy and it can reduce surgical stress, shorten hospital stay, improve quality of life and does not increase complications, whose mechanism may be associated with the reduction of inflammation and insulin resistance, the decrease of resting energy exposure, and the protection of mitochondria function. It is worth emphasizing that it is very important to fully understand the changes of pathophysiology during perioperative period, to strictly implement the ERAS pathway based on optimized evidence- based medicine, to cooperate closely with the muhidisciplinary team, to observe and manage the postoperative complications dynamically by systemic classification. The improvement of ERAS program on the outcome of patients should be summarized regularly and the new interventional strategies should be evaluated further according to the international standard.

关 键 词：加速康复外科 围手术期 胃肿瘤 机器人手术 

分 类 号：R735.2[医药卫生—肿瘤] TP242[医药卫生—临床医学]