| 标题： | 食管癌加速康复外科技术应用专家共识（2024版） |
| title： | Chinese Experts Consensus on Enhanced Recovery After Esophagectomy (2024 Edition) |
| 版本： | 更新版 |
| version： | Updated |
| 分类： | 专家共识 |
| classification： | Experts consensus |
| 领域： | 治疗 |
| field： | Treatment |
| 国家和地区： | 中国 |
| Country and region： | China |
| 指南使用者： | 包括但不限于各级医疗机构食管癌外科诊疗相关医务工作者。 |
| Guide users： | Including but not limited to medical workers related to the surgical treatment of esophageal cancer in medical institutions at all levels. |
| 证据分级方法： | 证据检索与评价小组对于纳入的随机对照试验研究采用Cochrane Reviewer′s Handbook 5.0.1标准进行评价，对于纳入的队列研究采用纽卡斯尔-渥太华量表进行评价，对于诊断准确性研究采用QUADAS-2进行评价，对于病例系列研究采用英国国立临床优化研究所评价工具进行评价。评价过程由2个人独立完成，若存在分歧，则共同讨论或咨询第三方解决。使用推荐意见分级的评估、制订及评价（grading of recommen-dations assessment，development and evaluation，GRADE）方法对证据质量和推荐意见进行分级。 |
| Evidence grading method： | The Evidence Retrieval and Evaluation Group evaluated the included randomized controlled trial studies using the Cochrane Reviewer′s Handbook 5.0.1 criteria, the included cohort studies using the Newcastle-Ottawa Scale, the diagnostic accuracy studies using the QUADAS-2, and the case-series studies using the United Kingdom's National Institute for Clinical Excellence Institute evaluation tool for case series studies. The evaluation process was completed independently by 2 individuals, and if disagreements existed, they were discussed together or resolved by consulting a third party. Quality of evidence and recommendations were graded using the grading of recommen-dations assessment, development and evaluation (GRADE) method. |
| 制定单位： | 国家癌症中心，中国医师协会胸外科医师分会，中华医学会胸心血管外科学分会，国际食管疾病学会中国分会 |
| Formulating unit： | Chinese National Cancer Center; Chinese Association of Thoracic Surgeons; Chinese Society for Thoracic and Cardiovascular Surgery; Chinese Society for Diseases of the Esophagus |
| 注册时间： | 2024-02-20 |
| Registration time： | |
| 注册编号： | PREPARE-2024CN282 |
| Registration number： | |
| 指南制订的目的： | 食管癌根治性切除联合淋巴结切除术是一项复杂的外科手术。对食管癌患者来说，围术期并发症发生率及死亡率风险均较高。加速康复外科（Enhanced Recovery After Surgery, ERAS）方案旨在改善围手术期护理、减少并发症并加快术后康复，以获得更好的围术期治疗效果。ERAS是一种包含多学科综合管理方法，其优点可缩短住院时间、降低发病率并加快术后康复。鉴于ERAS管理体系涉及围术期术前、术中及术后各阶段，故其各个环节应被视为一个连续步骤，而不是割裂的单元。在本共识中，我们详细阐述了食管切除术后ERAS方案的各组成部分，包括术前营养、术前预康复、咨询教育、戒烟戒酒、心肺功能评估、手术技巧、麻醉管理、术中及术后输液及镇痛管理、术后下床活动与理疗、经口进食时机及肠内营养支持方案、引流系统管理以及其他关键步骤问题。 |
| Purpose of the guideline： | Esophagectomy with radical lymphadenectomy is a complex surgery that carries a significant risk of morbidity and mortality for patients with esophageal cancer. The enhanced recovery after surgery (ERAS) protocol aims to improve perioperative care, minimize complications, and accelerate recovery for better outcomes. ERAS is a multimodal approach that can shorten hospital stays, decrease morbidity, and expedite recovery. ERAS components should be viewed as a continuum rather than isolated elements, as they span preoperative, intraoperative, and postoperative periods. In this consensus, we elaborate on the components of an ERAS protocol after esophagectomy, including preoperative nutrition, prehabilitation, counseling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anesthetic management, intra- and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. |
