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浙江大学学报（医学版）
浙江大学学报（医学版）  2017, Vol. 46 Issue (6): 666-674    DOI: 10.3785/j.issn.1008-9292.2017.12.15
综述     
加速康复外科在胰腺外科中的应用
冯梦宇(),张太平*(),赵玉沛
中国医学科学院 北京协和医学院 北京协和医院基本外科, 北京 100730
Present situation and prospect of enhanced recovery after surgery in pancreatic surgery
FENG Mengyu(),ZHANG Taiping*(),ZHAO Yupei
Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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摘要：

加速康复外科是基于循证医学证据，在多学科协作的基础上提出的一系列围手术期优化处理措施，可以通过减轻手术应激反应、合理的疼痛管理、早期恢复经口饮食和早期活动，达到加速术后康复的目的。与普通外科其他亚专科相比，胰腺外科具有疾病复杂、手术难度大、术后并发症发生率高等特点，因此，加速康复外科在胰腺外科中的应用相对滞后。本文针对胰腺外科的特点，首先探讨了加速康复外科在胰腺外科中应用的可行性和安全性，然后从术前干预、术中和术后管理三个层面详细阐述了加速康复外科在胰腺外科中的应用进展。
关键词： 加速康复外科;  胰腺/外科学;  手术期间;  手术后并发症/康复;  康复/方法;  安全性;  可行性研究;  综述    
Abstract:

Enhanced recovery after surgery is a multimodal perioperative strategy according to the evidence-based medicine and multidisciplinary collaboration, aiming to improve the restoration of functional capacity after surgery by reducing surgical stress, optimal control of pain, early oral diet and early mobilization. Compared with other sub-specialty in general surgery, pancreatic surgery is characterized by complex disease, highly difficult procedure and more postoperative complications. Accordingly, pancreatic surgery shares a slow development in enhanced recovery after surgery. In this review, the feasibility, safety, application progress, prospect and controversy of enhanced recovery after surgery in pancreatic surgery are discussed.
Key words: Enhanced recovery after surgery    Pancreas/surgery    Intraoperative period    Postoperative complications/rehabilitation    Rehabilitation/methods    Safety    Feasibility studies    Review
收稿日期: 2017-09-02 出版日期: 2017-12-25
CLC:  R657.5  
通讯作者: 张太平     E-mail: fmy0321@126.com;tpingzhang@yahoo.com
作者简介: 冯梦宇(1991-), 男, 博士研究生, 住院医师, 主要从事胰腺癌早期诊断和综合治疗研究; E-mail:fmy0321@126.com; https://orcid.org/0000-0003-3398-0941
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引用本文:

冯梦宇,张太平,赵玉沛. 加速康复外科在胰腺外科中的应用[J]. 浙江大学学报（医学版）, 2017, 46(6): 666-674.

FENG Mengyu,ZHANG Taiping,ZHAO Yupei. Present situation and prospect of enhanced recovery after surgery in pancreatic surgery. J Zhejiang Univ (Med Sci), 2017, 46(6): 666-674.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2017.12.15    或    http://www.zjujournals.com/med/CN/Y2017/V46/I6/666

1 WILMORE D W , KEHLET H . Management of patients in fast track surgery[J]. BMJ, 2001, 322 (7284): 473- 476
doi: 10.1136/bmj.322.7284.473
2 LASSEN K , COOLSEN M M , SLIM K et al. Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced Recovery After Surgery (ERAS?) Society recommendations[J]. Clin Nutr, 2012, 31 (6): 817- 830
doi: 10.1016/j.clnu.2012.08.011
3 KEHLET H . Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78 (5): 606- 617
doi: 10.1093/bja/78.5.606
4 楼文晖, 方圆 . 加速康复外科在胰腺外科中的应用[J]. 中华消化外科杂志, 2015, 14 (1): 29- 32
LOU Wenhui , FANG Yuan . Application of enhanced recovery after surgery in pancreatic surgery[J]. Chinese Journal of Digestive Surgery, 2015, 14 (1): 29- 32
5 江志伟, 黎介寿, 汪志明 et al. 胃癌患者应用加速康复外科治疗的安全性及有效性研究[J]. 中华外科杂志, 2007, 45 (19): 1314- 1317
JIANG Zhiwei , LI Jieshou , WANG Zhiming et al. The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy[J]. Chinese Journal of Surgery, 2007, 45 (19): 1314- 1317
doi: 10.3760/j.issn:0529-5815.2007.19.007
6 NYGREN J , THACKER J , CARLI F et al. Guidelines for perioperative care in elective rectal/pelvic surgery:Enhanced Recovery After Surgery (ERAS?) Society recommendations[J]. Clin Nutr, 2012, 31 (6): 801- 816
doi: 10.1016/j.clnu.2012.08.012
7 中国研究型医院学会肝胆胰外科专业委员会 . 肝胆胰外科术后加速康复专家共识(2015版)[J]. 中华消化外科杂志, 2016, 15 (1): 1- 6
Society for Hepatopancreatobiliary Surgery of Chinese Research Hospital Association . Expert consensus on enhanced recovery after hepatopanreatobiliary surgery (2015 edition)[J]. Chinese Journal of Digestive Surgery, 2016, 15 (1): 1- 6
8 MELLOUL E , HVBNER M , SCOTT M et al. Guidelines for perioperative care for liver surgery:enhanced recovery after surgery (ERAS) society recommendations[J]. World J Surg, 2016, 40 (10): 2425- 2440
doi: 10.1007/s00268-016-3700-1
9 中国加速康复外科专家组 . 中国加速康复外科围术期管理专家共识(2016版)[J]. 中华消化外科杂志, 2016, 15 (6): 527- 533
Chinese Expert Group for Enhanced Recovery after Surgery . Chinese expert consensus on enhanced recovery after surgery in perioperative management (2016 edition)[J]. Chinese Journal of Digestive Surgery, 2016, 15 (6): 527- 533
10 BERBERAT P O , INGOLD H , GULBINAS A et al. Fast track-different implications in pancreatic surgery[J]. J Gastrointest Surg, 2007, 11 (7): 880- 887
doi: 10.1007/s11605-007-0167-2
11 ROBERTSON N , GALLACHER P J , PEEL N et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy[J]. HPB(Oxford), 2012, 14 (10): 700- 708
12 COOLSEN M M , VAN DAM R M , VAN DER WILT A A et al. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies[J]. World J Surg, 2013, 37 (8): 1909- 1918
doi: 10.1007/s00268-013-2044-3
13 BRAGA M , PECORELLI N , ARIOTTI R et al. Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy[J]. World J Surg, 2014, 38 (11): 2960- 2966
doi: 10.1007/s00268-014-2653-5
14 NUSSBAUM D P , PENNE K , STINNETT S S et al. A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy[J]. J Surg Res, 2015, 193 (1): 237- 245
doi: 10.1016/j.jss.2014.06.036
15 白雪莉, 张晓雨, 卢芳燕 et al. 肝胆胰外科术后加速康复实施单中心经验[J]. 中华消化外科杂志, 2016, 15 (1): 35- 40
BAI Xueli , ZHANG Xiaoyu , LU Fangyan et al. Application of enhanced recovery after hepatopancreatobiliary surgery:a single-center experience[J]. Chinese Journal of Digestive Surgery, 2016, 15 (1): 35- 40
16 吕楠, 陆子鹏, 李强 et al. 加速康复外科在胰腺手术中的应用价值[J]. 中华消化外科杂志, 2016, 15 (6): 547- 551
LYU Nan , LU Zipeng , LI Qiang et al. Application value of enhanced recovery after surgery in the pancreatic surgery[J]. Chinese Journal of Digestive Surgery, 2016, 15 (6): 547- 551
17 SMITH I , KRANKE P , MURAT I et al. Perioperative fasting in adults and children:guidelines from the European Society of Anaesthesiology[J]. Eur J Anaesthesiol, 2011, 28 (8): 556- 69
doi: 10.1097/EJA.0b013e3283495ba1
18 MCLEOD R , FITZGERALD W , SARR M . Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery. 14. Preoperative fasting for adults to prevent perioperative complications[J]. Can J Surg, 2005, 48 (5): 409- 411
19 YUILL K A , RICHARDSON R A , DAVIDSON H I et al. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively-a randomised clinical trial[J]. Clin Nutr, 2005, 24 (1): 32- 37
doi: 10.1016/j.clnu.2004.06.009
20 Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters[J]. Anesthesiology, 2011, 114(3): 495-511.
21 HOLTE K , NIELSEN K G , MADSEN J L et al. Physiologic effects of bowel preparation[J]. Dis Colon Rectum, 2004, 47 (8): 1397- 1402
doi: 10.1007/s10350-004-0592-1
22 LAVU H , KENNEDY E P , MAZO R et al. Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy[J]. Surgery, 2010, 148 (2): 278- 284
doi: 10.1016/j.surg.2010.03.012
23 MCPHAIL M J , ABU HILAL M , JOHNSON C D . A meta-analysis comparing suprapubic and transurethral catheterization for bladder drainage after abdominal surgery[J]. Br J Surg, 2006, 93 (9): 1038- 1044
doi: 10.1002/(ISSN)1365-2168
24 ZAOUTER C , KANEVA P , CARLI F . Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia[J]. Reg Anesth Pain Med, 2009, 34 (6): 542- 548
doi: 10.1097/AAP.0b013e3181ae9fac
25 NELSON R , EDWARDS S , TSE B . Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2007, (3): CD004929
26 MANNING B J , WINTER D C , MCGREAL G et al. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy[J]. Surgery, 2001, 130 (5): 788- 791
doi: 10.1067/msy.2001.116029
27 QIU Y D , BAI J L , XU F G et al. Effect of preoperative biliary drainage on malignant obstructive jaundice:a meta-analysis[J]. World J Gastroenterol, 2011, 17 (3): 391- 396
doi: 10.3748/wjg.v17.i3.391
28 VAN DER GAAG N A , RAUWS E A , VAN EIJCK C H et al. Preoperative biliary drainage for cancer of the head of the pancreas[J]. N Engl J Med, 2010, 362 (2): 129- 137
doi: 10.1056/NEJMoa0903230
29 CONLON K C , LABOW D , LEUNG D et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection[J]. Ann Surg, 2001, 234 (4): 487- 493, 493-494
doi: 10.1097/00000658-200110000-00008
30 FISHER W E , HODGES S E , SILBERFEIN E J et al. Pancreatic resection without routine intraperitoneal drainage[J]. HPB(Oxford), 2011, 13 (7): 503- 510
31 VAN BUREN G , BLOOMSTON M , HUGHES S J et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage[J]. Ann Surg, 2014, 259 (4): 605- 612
doi: 10.1097/SLA.0000000000000460
32 STROBEL O , CHERREZ A , HINZ U et al. Risk of pancreatic fistula after enucleation of pancreatic tumours[J]. Br J Surg, 2015, 102 (10): 1258- 1266
doi: 10.1002/bjs.2015.102.issue-10
33 RICHARDSON J , DI F F , CLARKE H et al. Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy:feasibility, safety and cost analysis[J]. Pancreatology, 2015, 15 (2): 185- 190
doi: 10.1016/j.pan.2015.01.002
34 BASSI C , MOLINARI E , MALLEO G et al. Early versus late drain removal after standard pancreatic resections:results of a prospective randomized trial[J]. Ann Surg, 2010, 252 (2): 207- 214
doi: 10.1097/SLA.0b013e3181e61e88
35 VLUG M S , WIND J , HOLLMANN M W et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery:a randomized clinical trial(LAFA-study)[J]. Ann Surg, 2011, 254 (6): 868- 875
doi: 10.1097/SLA.0b013e31821fd1ce
36 LASSEN K , KJAEVE J , FETVEIT T et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity:a randomized multicenter trial[J]. Ann Surg, 2008, 247 (5): 721- 729
doi: 10.1097/SLA.0b013e31815cca68
37 GERRITSEN A , WENNINK R A , BESSELINK M G et al. Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity[J]. HPB(Oxford), 2014, 16 (7): 656- 664
38 BLOCK B M , LIU S S , ROWLINGSON A J et al. Efficacy of postoperative epidural analgesia:a meta-analysis[J]. JAMA, 2003, 290 (18): 2455- 2463
doi: 10.1001/jama.290.18.2455
39 UCHIDA I , ASOH T , SHIRASAKA C et al. Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique[J]. Br J Surg, 1988, 75 (6): 557- 562
doi: 10.1002/(ISSN)1365-2168
40 J?RGENSEN H , WETTERSLEV J , M?INICHE S et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery[J]. Cochrane Database Syst Rev, 2000, (4): CD001893
41 WERAWATGANON T , CHARULUXANUN S . Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery[J]. Cochrane Database Syst Rev, 2005, (1): CD004088
42 P?PPING D M , ELIA N , MARRET E et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery:a meta-analysis[J]. Arch Surg, 2008, 143 (10): 990- 999, 1000
doi: 10.1001/archsurg.143.10.990
43 BRUNS H , RAHBARI N N , L?FFLER T et al. Perioperative management in distal pancreatectomy:results of a survey in 23 European participating centres of the DISPACT trial and a review of literature[J]. Trials, 2009, 10 58
doi: 10.1186/1745-6215-10-58
44 PRATT W B , STEINBROOK R A , MAITHEL S K et al. Epidural analgesia for pancreatoduodenectomy:a critical appraisal[J]. J Gastrointest Surg, 2008, 12 (7): 1207- 1220
doi: 10.1007/s11605-008-0467-1
45 MCLEOD G , DAVIES H , MUNNOCH N et al. Postoperative pain relief using thoracic epidural analgesia:outstanding success and disappointing failures[J]. Anaesthesia, 2001, 56 (1): 75- 81
doi: 10.1046/j.1365-2044.2001.01763-7.x
46 SUC B , MSIKA S , PICCININI M et al. Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection:a prospective, multicenter randomized controlled trial[J]. Arch Surg, 2004, 139 (3): 288- 294, 295
doi: 10.1001/archsurg.139.3.288
47 CONNOR S , ALEXAKIS N , GARDEN O J et al. Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery[J]. Br J Surg, 2005, 92 (9): 1059- 1067
doi: 10.1002/(ISSN)1365-2168
48 LI-LING J , IRVING M . Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas:a systematic review of randomized controlled trials[J]. Br J Surg, 2001, 88 (2): 190- 199
doi: 10.1002/(ISSN)1365-2168
49 ALGHAMDI A A , JAWAS A M , HART R S . Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery:a systematic review and meta-analysis[J]. Can J Surg, 2007, 50 (6): 459- 466
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