肝切除ERAS指南2016

World JournalWorld J Surg(2016)40:2425-2440of SurgeryCrossMarkD0I10.1007s00268-016-3700-1SCIENTIFIC REVIEWGuidelines for Perioperative Care for Liver Surgery:EnhancedRecovery After Surgery (ERAS)Society RecommendationsEmmanuel Melloul12.Martin Huibner!.Michael Scott3.Chris Snowden45.James Prentis Cornelis H.C.Dejong?.O.James Garden.Olivier Farges.Norihiro Kokudo10.Jean-Nicolas Vauthey11.Pierre-Alain Clavien12.Nicolas DemartinesPublished online:22 August 2016Societe Internationale de Chirurgie 2016AbstractBackground Enhanced Recovery After Surgery (ERAS)is a multimodal pathway developed to overcome the delete-rious effect of perioperative stress after major surgery.In colorectal surgery,ERAS pathways reduced perioperativemorbidity,hospital stay and costs.Similar concept should be applied for liver surgery.This study presents the specificERAS Society recommendations for liver surgery based on the best available evidence and on expert consensusMethods A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline.Fiveindependent reviewers selected relevant articles.Quality of randomized trials was assessed according to the Jadadscore and CONSORT statement.The level of evidence for each item was determined using the GRADE system.TheDelphi method was used to validate the final recommendations.Results A total of 157 full texts were screened.Thirty-seven articles were included in the systematic review,and 16 ofthe 23 standard ERAS items were studied specifically for liver surgery.Consensus was reached among experts after 3rounds.Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted.The use of post-operative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay.Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery.Early oral intake and mobilization are recommended.There is noevidence to prefer epidural to other types of analgesia.Conclusions The current ERAS recommendations were elaborated based on the best available evidence and endorsedby the Delphi method.Nevertheless,prospective studies need to confirm the clinical use of the suggested protocol.Electronic supplementary material The online version of thisarticle (doi:10.1007/s00268-016-3700-1)contains supplementarymaterial,which is available to authorized users.☒Nicolas Demartinesdemartines@chuv.ch5 Institute of Cellular Medicine,The Medical School,1Department of Visceral Surgery,University HospitalUniversity of Newcastle upon Tyne,Newcastle upon Tyne,Lausanne.CHUV.Rue du Bugnon 46.1011 Lausanne.UKSwitzerland6Department of Perioperative and Critical Care Medicine,Recanati/Miller Transplantation Institute,Icahn School ofFreeman Hospital,Newcastle upon Tyne,UKMedicine at Mount Sinai.New York.USADepartment of Surgery,Maastricht University MedicalRoyal Surrey County Hospital NHS Foundation Trust.Center and NUTRIM School for Tr