从历史角度看结直肠术前肠道准备争议

加速康复外科（ERAS）概念自1999年由丹麦kehlet教授首次提出,其核心理念是在循证医学理念的基础上,对围术期进行一系列处理,减少手术创伤及应激对患者的伤害及体内平衡的干扰,使患者心理和生理状况尽快从手术中恢复,减少术后干扰并发症、缩短住院时间、再入院率。目前ERAS发展极为迅速,各大医疗中心均发展出自己特色的ERAS路径。我们在看到ERAS发展如此之快的同时,更应该注意到在ERAS推行过程中,其与传统理念及习惯的激烈碰撞,进而所产生对ERAS方案的疑问。其中就包括肠道准备。本文将从历史角度并综述国内外现有的关于肠道准备的证据,对肠道准备争议进行探讨。

A historical perspective on the controversy of preoperative bowel preparation in colorectal surgery

The concept of enhanced recovery after surgery (ERAS) was first proposed by professor Kehlet of Denmark in 1999. The core idea is to carry out a series of treatments on the perioperative period based on the concept of evidence-based medicine to reduce surgical trauma and stress. The disturbance of homeostasis makes the patient′s psychological and physiological conditions recover from surgery as soon as possible, reducing postoperative interference complications, shortening hospital stay, and re-admission rate. At present, ERAS is developed very rapidly, and all major centers have developed into their own unique ERAS path. While seeing the rapid development of ERAS, we should also pay attention to the fierce collision with traditional ideas and habits during the implementation of ERAS, and then raise questions about the ERAS solution. This paper will review the existing evidence of intestinal preparation at home and abroad and discuss the development of intestinal preparation from a historical perspective.