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中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (01) : 7 -14. doi: 10.3877/cma.j.issn.2095-7157.2025.01.003

共识与指南

抗栓药物治疗患者超级微创手术围手术期管理专家共识(2025,北京)
中华医学会消化内镜学分会1   
  1. 1. 100700 北京,中华医学会消化内镜学分会
  • 收稿日期:2025-02-05 出版日期:2025-02-15
  • 基金资助:
    国家重点研发计划(2022YFC2503600)

Expert consensus on perioperative management of super m inimally invasive surgery in patients receiving antithrombotic therapy (2025,Beijing)

Society of Digestive Endoscopology Chinese1   

  1. 1. Chinese Society of Digestive Endoscopology,Beijing 100700,China
  • Received:2025-02-05 Published:2025-02-15
引用本文:

中华医学会消化内镜学分会. 抗栓药物治疗患者超级微创手术围手术期管理专家共识(2025,北京)[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(01): 7-14.

Society of Digestive Endoscopology Chinese. Expert consensus on perioperative management of super m inimally invasive surgery in patients receiving antithrombotic therapy (2025,Beijing)[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(01): 7-14.

随着心脑血管疾病发病率的增加和人口老龄化,抗血栓药物在中国被广泛使用。 然而,接受超级微创手术(SMIS)患者的抗血栓药物管理仍面临重大挑战。 基于国内外循证医学证据,经中华医学会消化内镜学分会专家研讨制定形成了抗栓药物治疗患者SMIS 围手术期管理专家共识,以下简称《共识》,本《共识》形成10 条推荐意见,涵盖SMIS 术前评估、抗栓药物管理、手术风险分层及围术期胃肠保护策略,旨在优化SMIS 患者管理,实现最佳治疗效果与安全性。

With the increasing incidence of cardiovascular diseases and population aging,antithrombotic drugs have been widely used in China.However,the management of antithrombotic medications in patients undergoing super minimally invasive surgery (SMIS) still faces significant challenges.Based on domestic and international evidence-based medical research,experts from the Chinese Society of Digestive Endoscopology have developed the consensus on perioperative management of antithrombotic therapy in patients undergoing SMIS through extensive discussions.This consensus presents 10 recommendation items covering preoperative evaluation,antithrombotic medication management,surgical risk stratification,and perioperative gastrointestinal protection strategies for SMIS patients.It aims to optimize patient management during SMIS procedures while achieving optimal therapeutic outcomes and ensuring treatment safety.

表1 GRADE 证据质量等级
表2 GRADE 证据推荐强度分级
表3 -2 GIB 患者合并血栓风险时的抗凝方案
表4 四条通道的SMIS 手术术式
表5 四条通道SMIS 手术的出血风险
附录1 中英文缩略词表
中文全称 英文全称 英文缩写
急性冠脉综合征 acute coronary syndrome ACS
房颤 arial fibrillation AF
动脉粥样硬化性心血管疾病 atherosclerotic cardiovascular disease ASCVD
冷圈套息肉切除术 cold snare polypectomy CSP
双重抗血小板药物治疗 dual antiplatelet therapy DAPT
直接口服抗凝剂 direct oral anticoagulants DOACs
内镜下全层切除术 endoscopic full-thickness resection EFTR
内镜黏膜切除术 endoscopic mucosal resection EMR
内镜逆行胰胆管造影术 endoscopic retrograde cholangiopancreatography ERCP
内镜黏膜下剥离术 endoscopic submucosal dissection ESD
内镜黏膜下肿物挖除术 endoscopic submucosal excavation ESE
隧道法内镜黏膜下剥离术 endoscopic submucosal tunnel dissection ESTD
超声内镜引导消融术 endoscopic ultrasound-guided ablation EUS-A
胃肠道出血 gastrointestinal bleeding GIB
推荐的分级、评估、制定与评价 grading of recommendation, assessment, development, and evaluation GRADE
国际标准化比值 international normalized ratio INR
低分子量肝素 low molecular weight heparin LMWH
经皮冠状动脉介入治疗 percutaneous coronary Intervention PCI
经口内镜下肌切开术 peroral endoscopic myotomy POEM
质子泵抑制剂 proton pump inhibitor PPI
超级微创手术 super minimally invasive surgery SMIS
隧道法内镜黏膜下肿物切除术 submucosal tunnel endoscopic resection STER
短暂性脑缺血发作 transient ischemic attack TIA
维生素 K 拮抗剂 vitamin K antagonist VKA
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