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[多病共存患者的结直肠手术]

[Colorectal surgery in multimorbid patients].

作者信息

Dasevicius Romualdas, Presser Sabine Jeanette

机构信息

Klinik für Allgemein- und Viszeralchirurgie, SRH Zentralklinikum Suhl, Albert-Schweitzer-Straße 2, 98527, Suhl, Deutschland.

出版信息

Chirurgie (Heidelb). 2025 Feb;96(2):95-101. doi: 10.1007/s00104-024-02236-1. Epub 2025 Jan 29.

Abstract

Colorectal surgery in multimorbid patients requires a comprehensive interdisciplinary planning of the treatment approach, from preoperative to posthospital care, in order to minimize complications and improve the patient's outcome. Therefore, the integration of the outpatient and inpatient sectors is essential as is a perioperative interdisciplinary coordinated approach. Preoperatively, all possible risks of concomitant diseases must be considered and optimized if necessary. As part of the prehabilitation, physical exercise, optimization of eating habits and psychological care contribute to a reduction in the complication rate and a shortening of the duration of hospitalization. In older patients a comprehensive geriatric assessment improves the success of the treatment. Perioperatively, interdisciplinary care of the patient is required, whereby enhanced recovery after surgery (ERAS) programs, in particular an individually adapted volume therapy and risk-based planning of the surgical procedure, have a significant influence on the outcome. Posthospital care is also initiated through postoperative management in order to ensure continued outpatient care and surgical success.

摘要

对患有多种疾病的患者进行结直肠手术,需要对治疗方法进行全面的跨学科规划,从术前到出院后护理,以尽量减少并发症并改善患者的治疗效果。因此,门诊和住院部门的整合至关重要,围手术期的跨学科协调方法也是如此。术前,必须考虑所有伴随疾病的潜在风险,并在必要时进行优化。作为术前康复的一部分,体育锻炼、饮食习惯的优化和心理护理有助于降低并发症发生率并缩短住院时间。在老年患者中,全面的老年医学评估可提高治疗成功率。围手术期,需要对患者进行跨学科护理,其中加速康复外科(ERAS)计划,特别是个体化的容量治疗和基于风险的手术程序规划,对治疗效果有重大影响。出院后护理也通过术后管理启动,以确保持续的门诊护理和手术成功。

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