Протокол ускоренной реабилитации при панкреатодуоденальной резекции: несоответствие между доказательной базой и клинической практикой

Протоколы ускоренной реабилитации после хирургических вмешательств продемонстрировали эффективность при различных операциях в онкохирургии, однако их применение при панкреатодуоденальной резекции остается предметом дискуссий. Несмотря на растущую доказательную базу, демонстрирующую преимущества концепции ускоренной реабилитации при панкреатодуоденальной резекции, реальная клиническая практика характеризуется низким уровнем внедрения и значительной вариабельностью в применении отдельных компонентов протокола. В обзоре проведен анализ современных данных об эффективности концепции ускоренной реабилитации при панкреатодуоденальной резекции. Выявлены барьеры для внедрения концепции в клиническую практику, рассмотрены причины расхождения научных доказательств и клинической реальности. Анализ исследований показывает, что полное внедрение концепции ускоренного восстановления позволяет уменьшить частоту осложнений на 20–30 % и сократить продолжительность госпитализации на 3–5 дней, однако только 12–15 % центров применяют более 80 % рекомендованных элементов концепции. Основными барьерами являются организационные факторы, недостаток ресурсов, резистентность к изменениям устоявшейся практики и особенности хирургии поджелудочной железы.

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