妇科肿瘤围手术期管理的革命：从ERAS到预康复的系统性优化

The Revolution in Perioperative Management of Gynecologic Oncology: Systematic Optimization from ERAS to Prehabilitation

摘要: 妇科肿瘤约占全球女性新发癌症病例的15%，其围手术期管理面临传统护理模式预后不佳、循证依据薄弱、医疗质量异质性显著，以及高龄患者风险分层不完善、急性失血容量管理无统一标准等挑战。本文系统综述了妇科肿瘤围手术期管理的最新进展，重点探讨了从加速康复外科(Enhanced recovery after surgery, ERAS)到预康复策略的系统性优化路径。文章指出，传统围手术期护理模式存在住院时间长、并发症控制不佳及资源消耗大等问题，而ERAS通过多学科协作、微创技术、目标导向液体管理等核心要素，显著改善患者短期恢复结局。预康复作为新兴策略，通过术前运动、营养与心理干预提升患者生理及心理储备，与ERAS形成有效互补。文章还分析了特殊患者群体(如高龄、合并症及急性失血患者)的个体化管理策略，并探讨了人工智能在风险预测与个体化治疗中的潜在应用。尽管当前存在方案依从性不均、长期肿瘤学结局证据不足等挑战，整合ERAS与预康复的多模式干预方案仍是未来优化妇科肿瘤围手术期管理的关键方向。

Abstract: Gynecologic tumors account for approximately 15% of new cancer cases in women worldwide. Their perioperative management faces multiple challenges, including poor prognosis of traditional care models, weak evidence base, significant heterogeneity in medical quality, inadequate risk stratification for elderly patients, and lack of unified standards for acute blood loss volume management. This article systematically reviews the latest progress in perioperative management of gynecologic tumors, focusing on the systematic optimization path from Enhanced Recovery After Surgery (ERAS) to prehabilitation strategies. It points out that traditional perioperative care models have problems such as long hospital stays, poor complication control, and high resource consumption. In contrast, ERAS significantly improves patients’ short-term recovery outcomes through core elements including multidisciplinary collaboration, minimally invasive techniques, and goal-directed fluid therapy. As an emerging strategy, prehabilitation enhances patients’ physical and psychological reserves through preoperative exercise, nutrition, and psychological interventions, forming an effective complement to ERAS. The article also analyzes individualized management strategies for special patient groups (e.g., elderly patients, those with comorbidities, and patients with acute blood loss) and explores the potential application of artificial intelligence in risk prediction and individualized treatment. Despite current challenges such as uneven protocol compliance and insufficient evidence for long-term oncological outcomes, multimodal intervention regimens integrating ERAS and prehabilitation remain the key direction for optimizing perioperative management of gynecologic tumors in the future.