您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (11): 17-22.doi: 10.6040/j.issn.1671-7554.0.2022.0658

• 胸外科肺癌、食管癌微创诊治和加速康复专题 • 上一篇    下一篇

加速康复外科需要与时俱进

车国卫*()   

  1. 四川大学华西医院肺癌中心/胸外科，四川 成都 610041
  • 收稿日期:2022-05-27 出版日期:2022-11-01 发布日期:2022-11-04
  • 通讯作者: 车国卫 E-mail:chebenben2005@163.com
  • 作者简介:车国卫，四川大学华西医院肺癌中心主任医师、教授、博士研究生导师, 四川省学术和技术带头人。主要从事肺癌与肿瘤微环境共演进和分子机制、快速康复流程优化研究。任中华医学会胸心血管外科分会肺癌学组委员、中国临床肿瘤学协作中心(CSCO)理事、中国康复医学会呼吸专委会常委、中国医师协会康复专委会呼吸专委会副主任委员、世界中医药联合会肺康复专业委员会副会长、四川省医学会胸心外科分会副主委、四川省肿瘤学会理事、肺癌专委会副主委、四川省康复医学会常务理事、加速康复外科专委会主委、成都康复医学会肺康复专委会主任委员、《中国肺癌杂志》和《中国胸心血管外科临床杂志》常务编委。作为项目负责人共获得基金14项(国家自然科学基金4项、省部级基金10项)，主编专著8部，参与制订专家共识13项，以第一作者和通信作者发表论文240多篇，其中SCI收录140篇
  • 基金资助:
    四川省科技厅支撑计划项目(2015SZ0158);四川省科技厅计划项目(2021JDKP0046)

It is necessary for enhanced recovery after surgery to keep pace with the times

Guowei CHE*()   

  1. Lung Cancer Center/Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
  • Received:2022-05-27 Online:2022-11-01 Published:2022-11-04
  • Contact: Guowei CHE E-mail:chebenben2005@163.com

RichHTML

0

PDF (PC)

11

摘要：

微创外科技术和设备的发展不断推动加速康复外科(ERAS)的进步，不但持续更新我们对加速康复外科的再认识，反过来加速康复外科的理念和实现也需要与时俱进，共同发展。本文结合肺外科加速康复外科的临床实践，阐述加速康复外科需要更新和发展的几个方面：一是加速康复外科的目标或目的需要适应技术和时代的进步；二是加速康复外科团队建设与思考；三是加速康复外科管理与流程优化；四是加速康复外科在推动分级诊疗或全程管理中的应用。

关键词: 加速康复外科, 微创外科, 全程管理, 分级诊疗

Abstract:

The development of minimally invasive surgical techniques and equipment continues to promote the progress of enhanced recovery after surgery (ERAS) and update our understanding. Conversely, the concept and realization of ERAS also need to keep pace with the times. This article illustrates several aspects of ERAS which need to be updated and developed based on the clinical practice in lung surgery, including the goals or objectives of ERAS, team building and thinking about ERAS, management and process optimization of ERAS, and the application of ERAS in promoting tiered diagnosis and treatment or whole-process management.

Key words: Enhanced Recovery after Surgery, Minimally invasive surgery, Whole-process management, Tiered diagnosis and treatment

中图分类号: 

  • R655.3
1 Li S , Zhou K , Che G , et al. Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials[J]. Cancer Manag Res, 2017, 9, 657- 670.
doi: 10.2147/CMAR.S150500
2 车国卫, 刘伦旭, 石应康. 加速康复外科临床应用现状与思考[J]. 中国胸心血管外科临床杂志, 2016, 23 (3): 211- 215.
CHE Guowei , LIU Lunxu , SHI Yingkang . Enhanced recovery after surgery protocol applying in perioperative treatment: current status and issues[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23 (3): 211- 215.
3 车国卫, 李为民, 刘伦旭. 快速肺康复需要围手术期流程优化[J]. 中国胸心血管外科临床杂志, 2016, 23 (3): 216- 220.
CHE Guowei , LI Weimin , LIU Lunxu . Enhanced lung rehabilitation after surgery: peri-operative processes optimization is necessary[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23 (3): 216- 220.
4 Jiang L , Lei T , Zhou K , et al. Pivotal role of video-assisted thoracoscopic surgery in improving survival outcome of stage Ⅰ non-small cell lung cancer in day surgery patients[J]. Thorac Cancer, 2021, 12 (21): 2865- 2872.
doi: 10.1111/1759-7714.14145
5 Steenhagen E . Enhanced recovery after surgery: it's time to change practice![J]. Nutr Clin Pract, 2016, 31 (1): 18- 29.
doi: 10.1177/0884533615622640
6 Cotton P . Fast-track improves CABG outcomes[J]. JAMA, 1993, 270 (17): 2023.
doi: 10.1001/jama.1993.03510170013003
7 Miller TE , Roche AM , Mythen M . Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)[J]. Can J Anaesth, 2015, 62 (2): 158- 168.
doi: 10.1007/s12630-014-0266-y
8 Day RW , Cleeland CS , Wang XS , et al. Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery[J]. J Am Coll Surg, 2015, 221 (6): 1023- 1030.
doi: 10.1016/j.jamcollsurg.2015.09.011
9 Fagundes CP , Shi Q , Vaporciyan AA , et al. Symptom recovery after thoracic surgery: measuring patient-reported outcomes with the MD Anderson Symptom Inventory[J]. J Thorac Cardiovasc Surg, 2015, 150 (3): 613- 619.
doi: 10.1016/j.jtcvs.2015.05.057
10 Chen T , Wei H , Yue W , et al. Enhanced recovery after surgery management of perioperative period in surgical lung cancer patients: protocol for a systematic review and meta-analysis of randomised controlled trials[J]. BMJ Open, 2022, 12 (2): e056068.
doi: 10.1136/bmjopen-2021-056068
11 Li S , Che G , Shen C , et al. Current situation and consideration on the enhanced recovery protocols in lung cancer surgery[J]. J Thorac Dis, 2018, 10 (Suppl 33): S3855- S3858.
12 车国卫, 梁廷波. 加速康复外科临床实践中学科团队建设的问题与思考[J]. 加速外科康复杂志, 2019, 2 (4): 145- 148.
CHE Guowei , LIANG Tingbo . Current status and issues of disciplinary team protocol in Enhanced Recovery after Surgery (ERAS)[J]. Journal of Enhanced Recovery After Surgery, 2019, 2 (4): 145- 148.
13 Spencer P , Scott M . Implementing enhanced recovery after surgery across a United States Health System[J]. Anesthesiol Clin, 2022, 40 (1): 1- 21.
doi: 10.1016/j.anclin.2021.11.011
14 Choi BY , Bae JH , Lee CS , et al. Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery[J]. Ann Surg Treat Res, 2022, 102 (4): 223- 233.
doi: 10.4174/astr.2022.102.4.223
15 车国卫. 肺癌患者加速肺康复外科体系的建立与优化[J]. 中国肺癌杂志, 2017, 20 (12): 795- 799.
doi: 10.3779/j.issn.1009-3419.2017.12.01
CHE Guowei . Establishment and optimization of enhanced recovery after surgery system for lung cancer[J]. Chinese Journal of Lung Cancer, 2017, 20 (12): 795- 799.
doi: 10.3779/j.issn.1009-3419.2017.12.01
16 Meyenfeldt EMV , van Nassau F , de Betue CTI , et al. Implementing an enhanced recovery after thoracic surgery programme in the Netherlands: a qualitative study investigating facilitators and barriers for implementation[J]. BMJ Open, 2022, 12 (1): e051513.
doi: 10.1136/bmjopen-2021-051513
17 Goyal-Honavar A , Sarkar S , Asha HS , et al. Impact of experience on outcomes after endoscopic transsphenoidal surgery for acromegaly[J]. World Neurosurg, 2021, 151, e1007- e1015.
doi: 10.1016/j.wneu.2021.05.030
18 车国卫. 加速康复外科: 人文or技术?[J]. 中国肺癌杂志, 2018, 21 (3): 168- 172.
CHE Guowei . What is enhanced recovery after surgery: humanity or technology?[J]. Chinese Journal of Lung Cancer, 2018, 21 (3): 168- 172.
19 车国卫, 刘伦旭. 加速康复外科, 需要精准治疗吗?[J]. 中国肺癌杂志, 2017, 20 (8): 549- 554.
CHE Guowei , LIU Lunxu . Enhanced lung recovery after surgery, is it a necessary for precision therapy?[J]. Chinese Journal of Lung Cancer, 2017, 20 (8): 549- 554.
20 车国卫, 刘伦旭, 周清华. 加速康复外科从理论到实践: 我们需要做什么?[J]. 中国肺癌杂志, 2017, 20 (4): 219- 225.
CHE Guowei , LIU Lunxu , ZHOU Qinghua . Enhanced recovery after surgery from theory to practice: what do we need to do?[J]. Chinese Journal of Lung Cancer, 2017, 20 (4): 219- 225.
21 徐志华, 杨梅, 邱舫, 等. 肺癌患者围手术期无痛性留置导尿管的前瞻性队列研究[J]. 中国胸心血管外科临床杂志, 2016, 23 (4): 323- 327.
XU Zhihua , YANG Mei , QIU Fang , et al. Perioperative painless indwelling urethral catheter in lobectomy of lung cancer: a prospective cohort study[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23 (4): 323- 327.
22 车国卫. 加速康复外科——临床应用加减之间?[J]. 中国肺癌杂志, 2019, 22 (11): 681- 686.
CHE Guowei . Proper selection of enhanced recovery after surgery programs between the medical service and medical intervence—is it time to do?[J]. Chinese Journal of Lung Cancer, 2019, 22 (11): 681- 686.
23 Lai Y , Wang X , Zhou K , et al. The feasibility and safety of no placement of urinary catheter following lung cancer surgery: a retrospective cohort study with 2, 495 cases[J]. J Invest Surg, 2021, 34 (6): 568- 574.
24 Lai Y , Wang X , Zhou H , et al. Is it safe and practical to use a foley catheter as a chest tube for lung cancer patients after lobectomy? A prospective cohort study with 441 cases[J]. Int J Surg, 2018, 56, 215- 220.
doi: 10.1016/j.ijsu.2018.06.028
25 林琳, 戢艳丽, 车国卫, 等. 肺癌胸腔镜肺叶切除术后不同药物镇痛效果的随机对照试验[J]. 中国胸心血管外科临床杂志, 2017, 24 (11): 830- 834.
LIN Lin , JI Yanli , CHE Guowei , et al. Analgesic drugs for patients with non-small cell lung cancer undergoing video-assisted thoracic surgery lobectomy: a randomized controlled trial[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24 (11): 830- 834.
26 Li P , Shen C , Wu Y , et al. It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: a meta-analysis[J]. J Thorac Dis, 2018, 10 (5): 2712- 2721.
27 Lai Y , Su J , Qiu P , et al. Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial[J]. Interact Cardiovasc Thorac Surg, 2017, 25 (3): 476- 483.
28 Wang J , Dong Y , Su J , et al. Postoperative exercise training improves the quality of life in patients receiving pulmonary resection: A systematic review and meta-analysis based on randomized controlled trials[J]. Respir Med, 2022, 192, 106721.
doi: 10.1016/j.rmed.2021.106721
29 Lin R , Che G . Risk factors of cough in non-small cell lung cancer patients after video-assisted thoracoscopic surgery[J]. J Thorac Dis, 2018, 10 (9): 5368- 5375.
30 Zhou K , Lai Y , Wang Y , et al. Comprehensive pulmonary rehabilitation is an effective way for better postoperative outcomes in surgical lung cancer patients with risk factors: a propensity score-matched retrospective cohort study[J]. Cancer Manag Res, 2020, 12, 8903- 8912.
doi: 10.2147/CMAR.S267322
31 沈诚, 常帅, 周坤, 等. 加速康复外科和日间手术模式在胸外科中的应用现状及发展前景[J]. 中国肺癌杂志, 2020, 23 (9): 800- 805.
SHEN Cheng , CHANG Shuai , ZHOU Kun , et al. The present situation and prospect of day surgery and enhanced recovery after surgery in thoracic surgery[J]. Chinese Journal of Lung Cancer, 2020, 23 (9): 800- 805.
32 Shen C , Che G . No drains in thoracic surgery with ERAS program[J]. J Cardiothorac Surg, 2020, 15 (1): 112.
33 Jiang L , Lei T , Zhou K , et al. Pivotal role of video-assisted thoracoscopic surgery in improving survival outcome of stage Ⅰ non-small cell lung cancer in day surgery patients[J]. Thorac Cancer, 2021, 12 (21): 2865- 2872.
34 Dong Y , Shen C , Wang Y , et al. Safety and feasibility of video-assisted thoracoscopic day surgery and inpatient surgery in patients with non-small cell lung cancer: a single-center retrospective cohort study[J]. Front Surg, 2021, 8, 779889.
doi: 10.3389/fsurg.2021.779889
35 Dong Y , Li J , Chang J , et al. Video-assisted thoracoscopic day surgery for patients with pulmonary nodules: a single-center clinical experience of 200 cases[J]. Cancer Manag Res, 2021, 13, 6169- 6179.
doi: 10.2147/CMAR.S324165
36 董映显, 朱道珺, 车国卫, 等. 肺癌日间手术操作流程与临床应用效果分析[J]. 中国肺癌杂志, 2020, 23 (2): 77- 83.
DONG Yingxian , ZHU Daojun , CHE Guowei , et al. Clinical effect of day surgery in patients with lung caner by optimize operating process[J]. Chinese Journal of Lung Cancer, 2020, 23 (2): 77- 83.
37 刘丹, 黄燕, 周清华, 等. 肺结节/肺癌患者全程管理模式的设计与应用[J]. 中国肺癌杂志, 2020, 23 (5): 299- 305.
LIU Dan , HUANG Yan , ZHOU Qinghua , et al. Pulmonary nodules/lung cancer comprehensive management mode: design and application[J]. Chinese Journal of Lung Cancer, 2020, 23 (5): 299- 305.
[1] 胡冰涛,张文灿,王崇怡,林翔宇,王凯斌,冯运泽,刘郴,徐万龙,李乐,司海朋. 基于加速康复外科理念的单孔分体内镜微创技术治疗腰椎管狭窄症的临床效果分析[J]. 山东大学学报 (医学版), 2025, 63(3): 1-7.
[2] 马志虎,于晓凤,孙玉亮,王刚,裴艳涛,陈斌,史安浩,乔丽,朱磊. 加速康复外科综合治疗在三角纤维软骨复合体损伤患者围术期中的应用[J]. 山东大学学报 (医学版), 2025, 63(3): 28-35.
[3] 司海朋,王崇怡,宫桂青,张文灿,郭英俊,王凯斌,冯运泽,徐万龙,李乐. 加速康复外科在脊柱外科中的应用进展[J]. 山东大学学报 (医学版), 2024, 62(10): 8-17.
[4] 张杨,李晓旭. 加速康复外科理念在骨折治疗中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 18-25.
[5] 冯昌,郭岩,赵杰,赵鑫. 加速康复外科理念下超声引导区域阻滞在骨科手术中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 26-35.
[6] 姜任东,赵建莉,时超,贺业腾,袁振. 加速康复外科理念下全膝关节置换治疗类风湿关节炎与骨关节炎患者的临床疗效[J]. 山东大学学报 (医学版), 2024, 62(10): 62-67.
[7] 吕龙飞,李继如,翟允鹏,赵华善,郭锐,许洪修,黄赛,张士松. 单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的早期临床应用[J]. 山东大学学报 (医学版), 2024, 62(1): 57-62.
[8] 高树庚. 加速康复外科在肺癌围术期管理中的应用[J]. 山东大学学报 (医学版), 2022, 60(11): 1-10.
[9] 韩丁培,严越,曹羽钦,孙昕,胡琰霞,汪敏娴,罗艳,施咏梅,谢青,杭钧彪,李鹤成. 加速康复外科理念在胸外科临床实践指导的瑞金医院专家共识[J]. 山东大学学报 (医学版), 2022, 60(11): 11-16.
[10] 孙振国,田辉. 加速康复外科指导下微创食管癌切除术流程优化之齐鲁实践[J]. 山东大学学报 (医学版), 2022, 60(11): 33-37.
[11] 江志伟,王刚. 延迟性术后肠麻痹的概念及防治策略[J]. 山东大学学报 (医学版), 2020, 58(5): 1-5.
[12] 张永媛,王清亮,李向一,刘盈君,费剑春,杨杰. 2018年济南市某三甲医院31天内非计划再入院研究[J]. 山东大学学报 (医学版), 2020, 58(2): 90-95.
[13] 王波,熊颖,倪志福,屈振繁. 加速康复外科理念在1~3岁日间疝手术中的应用[J]. 山东大学学报 (医学版), 2020, 58(12): 92-96.
[14] 支梦伟,江志伟,戴新娟,王刚,程伟. 加速康复外科指导下胃癌患者围手术期心率变异度的临床观察[J]. 山东大学学报 (医学版), 2020, 58(11): 85-91.
[15] 李玉杰,韩伟,黄炜,董玉科,李韬,党燕伟,蔡晓清,申晓,龚文丹,许连方. 加速康复外科在44例悬雍垂腭咽成形术中的应用[J]. 山东大学学报 (医学版), 2020, 58(11): 92-97.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发