引用文本：康岳, 陈创奇. 2025版加速康复外科结直肠手术指南关键更新解读[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(1): 19-27.

作者：康岳，陈创奇

单位：中山大学附属第一医院胃肠外科中心，广东 广州 510080

Authors：Kang Yue, Chen Chuangqi

Unit：Gastrointestinal Surgery Center, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China

摘要：

随着循证医学证据的更新，加速康复外科（enhanced recovery after surgery, ERAS）的临床实践也在不断迭代。2025年，国际ERAS学会发布了最新的《择期结直肠手术围手术期护理指南》。与2018版不同，新版指南采用了“从头开始”的方法，基于PICO（人群、干预、对照、结果）原则对2000年至2023年的文献进行了系统性重构与分级评价。本文对新版指南的核心变化进行了深度解读，重点分析了机械性肠道准备联合口服抗生素的必要性、围手术期液体管理从“近零平衡”向“轻度正平衡”的策略转变、微创手术中胸段硬膜外麻醉的摒弃与多模式镇痛的建立，以及术后肠梗阻的多元化预防策略。新版指南更强调干预措施的精准化与安全性，旨在协助胃肠外科医师更新临床认知，优化围手术期诊疗路径，改善患者预后。

关键词：加速康复外科；结直肠手术；指南解读；机械性肠道准备；液体管理；多模式镇痛

Abstract：

With the continuous evolution of evidence-based medicine, clinical practices in enhanced recovery after surgery (ERAS) are undergoing constant iteration. In 2025, the ERAS Society released the latest Guidelines for perioperative care in elective colorectal surgery. Unlike the 2018 version, these new guidelines utilized a "de novo" approach, systematically reconstructing and grading literature from 2000 to 2023 based on PICO (population, intervention, comparison, outcome) principles. This article provides an in-depth interpretation of the core changes in the new guidelines, specifically analyzing the necessity of combining mechanical bowel preparation with oral antibiotics, the strategic shift in perioperative fluid management from "near-zero balance" to "slightly positive balance", the abandonment of thoracic epidural anesthesia in minimally invasive surgery in favor of multimodal analgesia, and diversified strategies for preventing postoperative ileus. The 2025 guidelines emphasize the precision and safety of interventions, aiming to assist gastrointestinal surgeons in updating clinical knowledge, optimizing perioperative care pathways, and improving patient outcomes.

Key words：Enhanced recovery after surgery; Colorectal surgery; Guideline interpretation; Mechanical bowel preparation; Fluid management; Multimodal analgesia

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