Kehlet H, Moesgaard F
Dept. of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
Scand J Gastroenterol Suppl. 1996;216:218-24. doi: 10.3109/00365529609094576.
Gastrointestinal surgery results in pain, profound endocrine metabolic changes and organ dysfunction, immunosuppression and decreased resistance to infection, fatigue and convalescence. The main pathogenetic mechanism is the surgical stress response, which may be reduced by minimal invasive (laparoscopic) surgical techniques and afferent neural and perhaps humoral mediator blockade. Subsequently, these techniques have been documented as reducing a variety of postoperative morbidity parameters. A unifying concept for control of the postoperative period is presented as a combined effort to enhance preoperative information, stress reduction and sufficient functional pain relief allowing early mobilization and oral nutrition. Preliminary data, in combination with laparoscopic surgery, suggest that this approach improves outcome significantly.
胃肠手术会导致疼痛、深刻的内分泌代谢变化、器官功能障碍、免疫抑制以及抗感染能力下降、疲劳和康复缓慢。主要发病机制是手术应激反应，微创（腹腔镜）手术技术以及传入神经和可能的体液介质阻断可减轻这种反应。随后，这些技术已被证明可降低各种术后发病参数。作为一种综合努力，提出了一个控制术后阶段的统一概念，即加强术前信息、减轻应激和充分缓解功能性疼痛，以实现早期活动和经口营养。初步数据与腹腔镜手术相结合表明，这种方法可显著改善治疗效果。
