王巍;潘凌亚;
WANG Wei;PAN Ling-ya;Department of Gynecological Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院妇科肿瘤中心

摘要(Abstract)：

加速康复外科(enhanced recovery after surgery,ERAS)目前已在全球范围内明确成为一项能够改善医疗服务、降低医疗成本的手术质量改善倡议。妇科/肿瘤ERAS指南发表于2016年2月,ERAS协会以及国际ERAS妇科分会于2019年2月依据现有最高质量的文献证据进行了首次更新。其中新增预康复、预防手术部位感染策略、患者报告结局、盆腔廓清及腹腔热灌注化疗、出院路径、ERAS评估及报告等6条,更新文献证据级别及推荐级别10条,其他5条未发生变化。本次指南更新从围手术期管理方面为妇科/肿瘤临床实践明确了发展方向。
Enhanced Recovery After Surgery( ERAS) is now firmly established as a global initiative for the improvement of surgical quality,which results in both clinical improvements and cost benefits to the healthcare system. The ERAS Gynecologic/Oncology guidelines were first published in February 2016. It had been updated in February 2019,representing the joint efforts of the ERAS Society( www. erassociety. org) and the authors from the international ERAS Gynecology chapters,to present an updated consensus review of perioperative care for gynecologic/oncology surgery based on the best current evidence. There are six new items for 2019 guidelines,including prehabilitation,surgical site infection reduction bundles,patient-reported outcomes,pelvic exenteration and hyperthermic intraperitoneal chemotherapy,discharge pathways,and audit and reporting.Compared with the 2016 guidelines,the currently updated guidelines have ten items with differences in the quality of evidence and recommendation grade and five items with no change. This updated ERAS guidelines aim to further disclose the direction of the perioperative clinical practice of gynecologic/oncology.

关键词(KeyWords)： 加速康复外科;妇科肿瘤;更新;指南解读
enhanced recovery after surgery;gynecologic oncology;update;guideline interpretation

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王巍;潘凌亚;
WANG Wei;PAN Ling-ya;Department of Gynecological Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

Email:

DOI:

参考文献(References)：

• [1] Ljungqvist O,Scott M,Fearon KC. Enhanced recovery after surgery:a review[J]. JAMA Surg,2017,152:292-298.
• [2] Nelson G,Altman AD,Nick A,et al. Guidelines for preand intra-operative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS)society recommendations—Part I[J]. Gynecol Oncol, 2016, 140:313-322.
• [3] Nelson G,Altman AD,Nick A,et al. Guidelines for postoperative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS)society recommendations—partⅡ[J]. Gynecol Oncol,2016,140:323-332.
• [4]中华医学会妇产科学分会加速康复外科协作组．妇科手术加速康复中国专家共识[J]．中华妇产科杂志，2019,54:1-7.
• [5] Nelson G,Bakkum-Gamez J,Kalogera E,et al. Guidelines for perioperative care in gynecologic/oncology:Enhanced Recovery After Surgery(ERAS)Society recommendations-2019 update[J]. Int J Gynecol Cancer,2019. doi:10.1136/ijgc-2019-000356.[Epub ahead of print.
• [6] Angioli R,Plotti F,Capriglione S,et al. The effects of giving patients verbal or written pre-operative information in gynecologic oncology surgery:a randomized study and the medical-legal point of view[J]. Eur J Obstet Gynecol Reprod Biol,2014,177:67-71.
• [7] Carli F,Silver JK,Feldman LS,et al. Surgical prehabilitation in patients with cancer:state-of-the-science and recommendations for future research from a panel of subject matter experts[J]. Phys Med Rehabil Clin N Am, 2017, 28:49-64.
• [8] Chen M,Song X,Chen LZ,et al. Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery:a meta-analysis of randomized controlled clinical trials[J]. Dis Colon Rectum,2016,59:70-78.
• [9] Kalogera E,Nitschmann CC,Dowdy SC,et al. A prospective algorithm to reduce anastomotic leaks after rectosigmoid resection for gynecologic malignancies[J]. Gynecol Oncol,2017,144:343-347.
• [10] ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection:results from an international registry[J]. Ann Surg,2015,261:1153-1159.
• [11] Gould MK,Garcia DA,Wren SM,et al. Prevention of VTE in nonorthopedic surgical patients:antithrombotic therapy and prevention of thrombosis,9th ED:American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest,2012,141:e227S-77.
• [12] Carrier M,Abou-Nassar K,Mallick R,et al. Apixaban to prevent venous thromboembolism in patients with cancer[J]. N Engl J Med,2019,21,380:711-719.
• [13] ACOG practice Bulletin No. 195:prevention of infection after gynecologic procedures[J]. Obstet Gynecol,2018,131:e172-e189.
• [14] Wong PF,Kumar S,Bohra A,et al. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery[J]. Br J Surg,2007,94:421-426.
• [15] Hopkins L,Brown-Broderick J,Hearn J,et al. Implementation of a referral to discharge glycemic control initiative for reduction of surgical site infections in gynecologic oncology patients[J]. Gynecol Oncol,2017,146:228-233.
• [16] Obermair A,Janda M,Baker J,et al. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer:results from a randomised controlled trial[J]. Eur J Cancer, 2012, 48:1147-1153.
• [17] Ramirez PT,Frumovitz M,Pareja R,et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer[J]. N Engl J Med Overseas Ed, 2018, 379:1895-1904.
• [18] Yeung SE,Hilkewich L,Gillis C,et al. Protein intakes are associated with reduced length of stay:a comparison between enhanced recovery after surgery(ERAS)and conventional care after elective colorectal surgery[J]. Am J Clin Nutr,2017,106:44-51.
• [19] Lee CT,Chang SS,Kamat AM,et al. Alvimopan acce-lerates gastrointestinal recovery after radical cystectomy:a multicenter randomized placebo-controlled trial[J]. Eur Urol,2014,66:265-272.
• [20] Elias KM,Stone AB,McGinigle K,et al. The Reporting on ERAS Compliance, Outcomes, and Elements Research(RECOvER)Checklist:A Joint Statement by the ERASand ERASUSA Societies[J]. World J Surg,2019,43:1-8.
• [21] Jones D,Musselman R,Pearsall E,et al. Ready to go home? patients'experiences of the discharge process in an enhanced recovery after surgery(ERAS)program for colorectal surgery[J]. J Gastrointest Su,2017,21:1865-1878.
• [22] Nelson G,Ramirez PT,Ljungqvist O,et al. Enhanced recovery program and length of stay after laparotomy on a Gynecologic Oncology service:A Randomized Controlled Trial.[J]. Obstet Gynecol,2017,129:1139.