快速康复外科理念在肝移植围手术期应用的研究进展

摘要

As a new kind of perioperative management strategy and ideas,enhanced recovery after surgery (ERAS) brings a series of traditional perioperative treatment measures for optimization based on evidence-based medicine.Its primary aim is to decrease surgery-related stress,complications,and also to facilitate recovery with multimodal treatments.The ERAS pathway has been widely applied and proved to be efficient in gastrointestinal,colorectal,orthopedic,thoracic and gynecological surgery.Owing to the complexity of surgical procedure,long operation time and high perioperative complication rate in liver transplantation compared with other surgeries.This new concept has not been widely accepted or recommended in liver transplantation,although some previous studies have validated its safety and effectiveness.This paper overviewed the recent literature on the specific procedures,efficacy,safety and development of ERAS applied in liver transplantation.%快速康复外科(ERAS)是一种全新的围手术期管理策略和理念.它基于循证医学证据将一系列传统的围手术期处理措施进行了优化.其目的旨在运用多种医疗模式、手段,减轻患者术后应激反应,减少患者器官功能障碍等术后并发症,促进患者术后机体功能恢复,从而达到快速康复的目的.目前,ERAS已广泛应用于胃结直肠外科、骨科、胸外科、妇科等外科手术中.临床实践证实其在减少患者术后并发症,缩短术后住院日,降低住院费用等方面具有良好的效果.同其他外科手术相比,肝移植手术具有难度大、时间长、术后并发症发生率高等特点.尽管已经有部分研究表明ERAS应用于肝移植手术是安全有效的,但是尚未得到普遍接受和推广.本文结合近年来国内外相关文献报道,对ERAS在肝移植手术中的应用形式、疗效、安全性及其发展作一综述.