文献综述(Review)

胰十二指肠切除术围术期规范化开展加速康复外科的几点争议

Published at: 2017年第26卷第9期

卢昕 1 , 金浩生 1 , 侯宝华 1 , 简志祥 1
1 广东省人民医院 普通外科/广东省医学科学院,广东 广州 510080
通讯作者 志祥 简 Email: jzx_118@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.09.020
基金:

摘要

胰十二指肠切除术(PD)是普通外科最为复杂的手术之一,手术吻合口多,出现胰瘘、胆瘘、腹腔感染等并发症的风险大,围术期管理困难。近年提倡并应用的精准、微创、损伤控制的现代外科理念为加速康复外科(ERAS)的施行奠定了基础,尽管国际上已发布纲要性的共识指南,国内对于PD围手术期管理中实施ERAS仍存在不少争议。为了在PD围术期规范化开展ERAS,笔者就术前禁食禁饮时间、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的争议问题进行讨论和阐释。


Controversies on carrying out standardized enhanced recovery after surgery program in perioperative management of pancreaticoduodenectomy

Abstract

Pancreaticoduodenectomy (PD) is one of the most complex procedures in the field of general surgery, which involves multiple anastomoses and has a high risk of complications such as pancreatic fistula, biliary fistula and abdominal infection, leading to a difficult perioperative management. The currently advocated and implemented surgical concepts of precision, minimal invasion and damage control have laid the foundation for the employment of enhanced recovery after surgery (ERAS). Although the international directive consensus and guidelines have been issued, there are still controversies concerning the use of ERAS program in perioperative management of PD in China. For carrying out the standardized ERAS protocols in perioperative management of PD, the authors discuss and classify several highly controversial subjects such as preoperative fasting time for food and water, timing for nasogastric tube and peritoneal drainage tube removal, and administration of postoperative somatostatin.


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引用

引用本文: 昕 卢, 浩生 金, 宝华 侯, 志祥 简. 胰十二指肠切除术围术期规范化开展加速康复外科的几点争议 [J]. 中国普通外科杂志, 2017, 26(9): 1207-1211.
Cite this article as: LU Xin, JIN Haosheng, HOU Baohua, JIAN Zhixiang . Controversies on carrying out standardized enhanced recovery after surgery program in perioperative management of pancreaticoduodenectomy[J]. Chin J Gen Surg, 2017, 26(9): 1207-1211.