ПРИМЕНЕНИЕ ПРИНЦИПОВ УСКОРЕННОЙ РЕАБИЛИТАЦИИ (ERAS-ПРОТОКОЛА) В ОПЕРАТИВНОЙ ГИНЕКОЛОГИИ
Основное содержимое статьи
Аннотация
В статье представлен современный взгляд на применение протоколов ускоренной реабилитации (Enhanced Recovery After Surgery – ERAS) в оперативной гинекологии. Рассмотрены исторические аспекты развития концепции, ее патофизиологическое обоснование, ключевые компоненты на предоперационном, интраоперационном и послеоперационном этапах. Проанализированы преимущества внедрения ERAS-протоколов, включающие сокращение сроков госпитализации, снижение частоты послеоперационных осложнений и экономическую эффективность. Особое внимание уделено адаптации протоколов для различных гинекологических вмешательств – от доброкачественной патологии до онкогинекологических операций. Освещены современные направления развития концепции, включая телемедицинское сопровождение и оптимизацию обезболивания.
Ключевые слова
Информация о статье
Информация о финансировании и конфликте интересов
Авторы заявляют об отсутствии явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.
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Список литературы
1. Elias KM. The Evolution of Enhanced Recovery After Surgery (ERAS) in Gynecology: An Introduction. Clin Obstet Gynecol. 2025; 68(4): 473-478. doi: 10.1097/GRF.0000000000000965
2. Khanam Z, Nigam A. Enhanced Recovery after Surgery Protocol in Gynecologic Oncology: A Narrative Review. Journal of Colposcopy and Lower Genital Tract Pathology. 2025; 3(1): 19-24. doi: 10.4103/JCLGTP.JCLGTP_9_25
3. Radha M, Donimath K, Harshitha H, Kurdi M, Theerth K. Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol Implementation in Major Gynecologic Procedures: A Prospective Case-Control Study. Cureus. 2025; 17(5): e84335. doi: 10.7759/cureus.84335
4. Puchkov KV, Korenaya VV, Podzolkova NM. Fast track: surgical protocols of accelerated rehabilitation in gynecology. Gynecology. 2015; 17(3): 40-45. Russian (Пучков КВ, Коренная ВВ, Подзолкова НМ. Fast track: хирургические протоколы ускоренной реабилитации в гинекологии //Гинекология. 2015. Т. 17, № 3. С. 40-45.)
5. Bourazani M, Papatheodorou D, Galanis P, Poulopoulou S, Anagnostopoulos A, Vasilopoulos G, et al. Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynaecologic Oncology: A Randomized Clinical Trial. Asian Pac J Cancer Prev. 2025; 26(9): 3247-3257. doi: 10.31557/APJCP.2025.26.9.3247
6. Rusnell L, Nelson G. Future Directions in Enhanced Recovery After Surgery (ERAS) for Gynecologic Surgery. Clini Obstet Gynecol. 2025; 68(4): 538-543. doi: 10.1097/GRF.0000000000000967
7. Xu J, Liu S, Liu D, Wang Y, Tang M. The effect of enhanced recovery after surgery on the risk factors of venous thromboembolism for patients with gynecologic malignancies. Front Oncol. 2025; 15: 1627605. doi: 10.3389/fonc.2025.1627605
8. Vazquez EFO, Victoria JCL, López GAC, Tapia ECH, Acosta FIM, Namcela SDRP. Minimally Invasive Gynecologic Surgery and Enhanced Recovery and Outcomes: A Literature Review. Cureus. 2025; 17(5): e84814. doi: 10.7759/cureus.84814
9. Nelson G, Fotopoulou C, Taylor J, Glaser G, Bakkum-Gamez J, Meyer LA, et al. Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges – 2023 update. Gynecol Oncol. 2023; 173: 58-67. doi: 10.1016/j.ygyno.2023.04.009
10. Nian J, Li Z, Chen P, Ye P, Liu C. Enhanced recovery after surgery versus conventional postoperative care in patients undergoing hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024; 310(1): 515-524. doi: 10.1007/s00404-024-07475-5
11. Black KA, Nelson G. Outcomes and Metrics of Enhanced Recovery After Surgery (ERAS) in Gynecology. Clin Obstet Gynecol. 2025; 68(4): 532-537. doi: 10.1097/GRF.0000000000000968
12. Giannakidis D, Bagiasta A, Papageorgakopoulou M, Koutras A, Tsakiri I, Siristatidis CS, Papapanou M. Perioperative enhanced recovery after surgery (ERAS) for non-malignant gynaecological conditions (Protocol). Cochrane Database Syst Rev. 2025; 4(4): CD016165. doi: 10.1002/14651858.CD016165
13. Bourazani M, Fyrfiris N, Galanis P, Maglari C, Anagnostopoulos A, Papatheodorou DC, et al. Effect of Opioid-Sparing Multimodal Anesthesia Within an Enhance Recovery After Surgery (ERAS) Protocol on Postoperative Recovery in Gynecologic Oncology Surgery: A Randomized Clinical Study. Cureus. 2026;18(3):e104812. doi: 10.7759/cureus.104812
14. Lisovskaya EV, Khilkevich EG, Chuprynin VD, Melnikov MV, Filippovich GV. Protocols for accelerated postoperative recovery in patients with deep infiltrating colorectal endometriosis. Obstetrics and Gynecology. 2019; (1): 34-41. Russian (Лисовская Е.В., Хилькевич Е.Г., Чупрынин В.Д., Мельников М.В., Филиппович Г.В. Протоколы ускоренного выздоровления после операции у пациенток с глубоким инфильтративным колоректальным эндометриозом //Акушерство и гинекология. 2019. № 1. С. 34-41.) doi: 10.18565/aig.2019.1.34-41
15. Bisch SP, Jago CA, Kalogera E, Ganshorn H, Meyer LA, Ramirez PT, et al. Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology – a systematic review and meta-analysis. Gynecol Oncol. 2021; 161(1): 46-55. doi: 10.1016/j.ygyno.2021.01.015
16. Zhang X, Tu H, Yin Q, Li D, Wang L, Cao S, et al. Prevention of venous thrombosis through intraoperative intermittent pneumatic compression (IPC): a best practice implementation project. BMC Nurs. 2024; 23(1): 1-12. doi: 10.1186/s12912-024-02221-3
17. Stefanescu VC, Ionescu AM, Florea SF, Bataila V, Mandi DM, Faur FI, Cochior D. The role of minimally invasive surgery in the success of ERAS protocols. Arch Balk Med Union. 2025; 60: 84-90. doi: 10.31688/ABMU.2025.60.1.09
18. ERAS® Society. 11th ERAS World Congress, September 17-19th 2025, Turin, Italy. URL: https://erassociety.org/event/11th-eras-world-congress-september-17-19th-2025-turin-italy/ (дата обращения: 16.04.2026)
19. Marchetti M, Pan TL, Delfrati S, Gill S, Yates E, Meschini T, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic surgery: hot topic debates at the 2025 ERAS World Congress. Int J Gynecol Cancer. 2026; 36(4): 104552. doi: 10.1016/j.ijgc.2026.104552
20. Gnanarathne S, Rathnayaka T, Jayawardana M. Comparison of outcomes following ERAS versus conventional care in gynecological surgeries: a retrospective study. Anaesth, Pain Intensive Care. 2026; 30(2): 200-206. doi: 10.35975/apic.v30i2.3127
21. Ibanoglu MC, Kinay T, Engin-Ustun Y. Enhanced recovery after gynecologic surgery: review of the literature. Clinical and Experimental Obstetrics & Gynecology. 2022; 49(2): 46. doi: 10.31083/j.ceog4902046
22. Taliento C, Scutiero G, Milano C, Grasso M, Nitti F, Brasile O, et al. Surgical site infections and sepsis in gynecological surgery. Int J Gynecol Obstet. 2026;172(1):92-103. doi: 10.1002/ijgo.70356
23. Liu SF, Fang L, Zhang H. Analysis of clinical effect of gynecological laparoscopic day surgery based on ERAS. Shoushu Dianzi Zazhi (Journal of Surgical Electronics). 2025; 12(6): 83-86. doi: 10.3969/j.issn.2095-8331.2025.06.018
24. Baylor Scott & White Health. vNotes Hysterectomy. 2026. URL: https://www.bswhealth.com/treatments-and-procedures/vnotes-hysterectomy (дата обращения: 29.04.2026).
25. Musin II, Berg EA, Yashchuk AG, Molokanova AR, Murtazina GKh, Imelbaeva AG, et al. vNOTES hysterectomy. Obstetrics and Gynecology. 2026; (3): 95-103. Russian (Мусин И.И., Берг Э.А., Ящук А.Г., Молоканова А.Р., Муртазина Г.Х., Имельбаева А.Г., и др. vNOTES hysterectomy //Акушерство и гинекология. 2026. № 3. С. 95-103.) doi: 10.18565/aig.2025.332
26. Xu Y, Huang Y. Single-use laparoscopy combined with ERAS in infertility surgery. Journal of Reproductive Medicine. 2022; 14: 11-14.
27. Fang L, Zhang H, He LY, Wu CL. Application of ERAS based whole course nursing checklist in patients undergoing laparoscopic hysterectomy. Shoushu Dianzi Zazhi (Journal of Surgical Electronics). 2025;12(1):70-74. doi: 10.3969/j.issn.2095-8331.2025.015.017
28. Ribero L, Santía MC, Borchardt K, Zabaneh F, Beck A, Sadhu A, et al. Surgical site infection prevention bundle in gynecology oncology surgery: a key element in the implementation of an enhanced recovery after surgery (ERAS) program. Int J Gynecol Cancer. 2024; 34(9): 1445-1453. doi: 10.1136/ijgc-2024-005423
29. Polková M, Koliba P, Kabele P, Dubová O, Hodyc D, Škodová MK, et al. How can we reduce healthcare costs by using Enhanced Recovery After Surgery more effectively in different groups of gynaecological patients? A single-centre experience. J Eval Clin Pract. 2025; 31(3): e14196. doi: 10.1111/jep.14196
30. Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery. Int Urogynecol J. 2022; 33(11): 2921-2940. doi: 10.1007/s00192-022-05336-2
31. Douligeris A, Kathopoulis N, Karasmani C, Kypriotis K, Zacharakis D, Mortaki A, et al. Impact of Enhanced Recovery After Surgery (ERAS) guidelines implementation in deep infiltrating endometriosis surgery. A systematic review and meta-analysis. Facts Views Vis Obgyn. 2025; 17(1): 15-29. doi: 10.52054/FVVO.17.1.003
32. Fernandez S, Trombert-Paviot B, Raia-Barjat T, Chauleur C. Impact of Enhanced Recovery After Surgery (ERAS) program in gynecologic oncology and patient satisfaction. J Gynecol Obstet Hum Reprod. 2023;52(2):102528. doi: 10.1016/j.jogoh.2022.102528
33. ERAS® Interactive Audit System. Procedure List for Gynecology. ERAS® Society. 2025