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癌症患者的术前评估与管理

Authors
Ellen F Manzullo, MD, FACP
Sunil K Sahai, MD, FAAP, FACP
Harrison G Weed, MS, MD, FACP
Section Editor
Reed E Drews, MD
Deputy Editor
Sadhna R Vora, MD
Translators
李晓军, 副主任医师，副教授

引言

癌症患者的术前管理可能比较复杂。虽然癌症患者与非癌症患者在许多方面都是相似的，但癌症的直接或者间接(全身性)作用，以及癌症治疗的副作用都会影响癌症患者的术前评估与管理。本专题我们将概述与现患或者曾患癌症患者相关的术前评估与管理问题。一般术前评估和手术的心脏风险估计将在别处讨论。 (参见“健康患者的术前医疗评估”和“非心脏手术前的心脏风险评估”)

癌症患者的术前医学评估除了要评估一般医疗问题外，还要包括营养状态、功能状态以及症状控制(尤其是癌症相关疼痛的控制)的评估。还要考虑所患癌症的自然病程以及既往任何化疗或放疗的影响。年龄较大患者行癌症手术的短期和长期结局可能与较年轻患者相当。治疗方面的考虑应该基于患者的功能状态，而不是患者的实际年龄[1]。 (参见“癌症患者的老年综合评估”)

患者接受癌症外科手术治疗的时机和目的会影响术前评估。虽然癌症手术很少是紧急的，但通常也不是择期手术，因此将患者的医疗状态调整到最佳的时间比较有限。

内科医生除了要治疗患者的共存疾病，他们在协调外科医生、内科肿瘤医生、放射肿瘤医生以及其他人提供的不同级别复杂治疗中也发挥重要作用。

营养

癌症患者会因为多种原因而变得显著营养不良。疼痛、恶心、口炎或累及口咽或胃肠道的肿瘤可能会影响患者的饮食，此外，身体的代谢异常可能会引起厌食及体重减轻。 (参见“癌症恶病质的发病机制、临床特征及评估”)

                                  

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Literature review current through: 2017-07 . | This topic last updated: 2015-10-05.
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