肝癌病人TACE术后护理及舒适度分析

目的了解肝癌患者动脉化疗栓塞术(TACE)后不适情况,分析引起不适原因,探讨有效的护理干预措施。方法选取2012年6月至2014年6月我院收治的150例肝动脉化疗栓塞术后患者为调查对象,采用《TACE术后病人舒适度改变原因与舒适护理调查问卷》对患者进行调查;采用美国国立卫研究所制订的视觉模拟评分法(VAS评分)测评患者的舒适度。分析引起患者不适的原因,探讨相应的护理干预措施。结果通过调查发现,150例TACE患者术后普遍出现不适,其中极重度不适7例占4.7%,重度不适44例占29.3%,中度不适57例占38.0%,轻度不适42例占28.0%。引起不适的原因较多,常见原因有活动受限(12.7%)、恶心呕吐(20.7%)、厌食(10.0%)、腹痛腹胀(22.7%)、尿潴留(28.0%)。结论肝动脉化疗栓塞术患者术后普遍存在不适情况,部分患者出现极重度不适和重度不适,严重影响患者的后续治疗和生活质量。     

无痛支气管镜检查在70岁以上老年人中的安全性和舒适性

目的评价无痛支气管镜检查在70岁以上老年人中的安全性、舒适性。方法比较无痛组和对照组病例在检查前、后的平均动脉压（MAP）,心率（HR）,指脉氧饱和度（SpO2）,呼吸（RR）等生命体征的变化、不适反应以及术后患者对支气管镜检查的满意度。结果无痛组与对照组检查中MAP比较差异有显著性（P〈0.01）。两组患者的不适反应程度和满意度的比较差异有显著性（P〈0.01）,无痛组的不适反应程度轻;病人的满意度高,优于普通组。结论对70岁以上老年人进行无痛支气管镜检查,安全、有效、舒适性好。     

舒适护理在全脑血管造影术中的实施

经股动脉穿刺全脑血管造影（DSA）术是诊断脑血管病的重要检查方法之一,针对DSA术后病人在心理、卧位、排便、睡眠方面的不舒适问题,自2008年开始,我们在病人病情允许的条件下将舒适护理融人DSA术围手术期护理过程中,提高了病人的舒适程度,减少并发症,取得良好效果,现报道如下。     

个性化护理干预降低经皮冠状动脉介入治疗后不适的效果评价

目的探讨择期经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后患者舒适状况的影响因素,评价个性化护理干预对降低PCI治疗后不适的效果。方法采用自行设计的一般资料调查表、简化的舒适状况量表(GCQ)调查200例PCI治疗后患者,并将200例患者按电脑随机数字表法随机分为干预组与对照组。干预组给予个性化的整体护理干预,对照组实施PCI治疗常规护理。比较两组术后的舒适状况及其影响因素。结果干预组出现不舒适的例数明显少于对照组,差异有统计学意义(P<0.05),且其不舒适程度亦显著低于对照组,差异也有统计学意义(P<0.05)。结论对择期PCI治疗的患者实施个性化的护理干预可减少患者术后不适,降低术后不适程度,促进患者康复。     

舒适护理在老年急性心肌梗死病人中的应用

随着社会发展及医疗条件的不断改善,我国已步入老龄化社会,急性心肌梗死(AMI) 的老年病人日益增多, 由于老年病人生理机能老化,自理能力减弱,AMI时剧烈疼痛和濒死感给病人造成恐惧、悲观等情绪变化,而长时间卧床和制动使病人出现腰背酸痛、便秘、尿潴留、失眠等不适症状,使病人存在着不同程度的生理及心理不适,影响疗效.笔者应用舒适护理[1],根据老年AMI病人的生理、心理特点,找出病人不舒适的原因,在满足病人的要求且不影响并发症的前提下,采取有效的舒适护理措施,减轻了病人的痛苦和不舒适.现报道如下.     

个性化疼痛护理在缓解妇科腹腔镜术后非切口性疼痛中的疗效观察

[目的]探讨个性化疼痛护理对妇科腹腔镜术(LS)后非切口性疼痛中的缓解作用。[方法]选择我院接受妇科LS术的病人96例,随机分成观察组和对照组各48例,观察组病人在手术期间给予个性化的疼痛护理,对照组仅给予常规护理。护理前后利用数字评分法(VAS)疼痛评分对两组病人的疼痛情况进行评价,并进行护理满意度调查。[结果]观察组病人非切口性疼痛发生率、重度疼痛率和疼痛持续时间分别为41.7%、4.2%和4.4h±3.9h,对照组分别为72.9%、25.0%和16.2h±5.8h,两组比较差异有统计学意义(P<0.05);两组病人术前VAS评分相比,差异无统计学意义(P>0.05),观察组术后12h和术后24hVAS评分明显低于对照组,差异有统计学意义(P<0.05);观察组护理满意度为91.7%,对照组护理满意度为68.8%,两组差异均有统计学意义(P<0.05)。[结论]个性化疼痛护理对妇科LS术后非切口性疼痛具有显著的缓解作用,可提高病人对护理服务的满意度。     

维生素C脱碘对内镜下食管碘染色的老年病人舒适度及护理满意度的影响

目的探讨维生素C注射液(VCS)脱碘对内镜下食管碘染色的老年病人舒适度及护理满意度的影响。方法利用随机数表法将2019年3~4月南京医科大学第一附属医院52例内镜下食管碘染色后脱碘处理的老年病人(>60岁),随机分为VCS组和生理盐水(NS)组,每组26例。根据Bruggrmann舒适度评分制定舒适度评分表及简易护理满意度量表,对检查结束时和检查后30 min 2组病人的舒适度和护理满意度进行评分和比较分析。结果碘染后急性症状主要为胸骨后不适,迟发反应以上腹部不适为主。检查结束时VCS组的胸骨后不适发生率明显低于NS组(P=0.02);检查后30 min VCS组咽喉不适较NS组明显缓解(P=0.02)。VCS组护理满意度总评分、沟通与解释和专业水平评分均高于NS组(均P<0.05)。结论VCS脱碘能显著改善老年病人碘染后的胸骨后不适和咽喉部不适,提高护理满意度。     

针刺内关及足三里穴在胃镜检查术中的应用

[目的]探讨针刺内关、足三里穴防治胃镜检查术中恶心、呕吐的效果。[方法]将患者随机分为针刺内关(手穴)组、足三里(足穴)组、内关与足三里联合应用(联合)组及对照(药物)组,观察各组患者胃镜检查术中恶心(含呕吐)的次数,幽门运动情况,检查结束后评定患者的咽部不适程度、总体不适程度,比较各组积分。[结果]手穴组、足穴组、联合组在恶心次数、咽部不适、整体不适、积分方面与药物组相比差异均有统计学意义(P<0.05,<0.01);手穴组、足穴组、联合组之间差异无统计学意义;各组幽门痉挛的程度、幽门松弛的程度肉眼观察无明显差异,各组正常与异常的比例无统计学意义。[结论]针刺防治胃镜检查不良反应行之有效,临床可单取内关。     

舒适护理在纤支镜检查中应用效果观察

目的探讨舒适护理在纤支镜检查中的效果。方法针对患者的不同特点,采取不同的护理方法,增强患者在检查过程中的心理生理舒适感。结果经过舒适护理后,减轻了患者的心理压力,使患者能够舒适、安全、顺利完成了检查。结论舒适护理注重个性化护理,使患者不论在心理、生理上都比较满意,丰富了整体护理的内涵,真正做到了人性化服务,减低了患者的不适程度,从而提高了患者的满意度。     

影响PTCA术后舒适度的因素分析及护理

目的 对影响PTCA术后24h内，舒适度的相关因素进行分析，提出护理对策，增进病人的舒适程度，提高PTCA术后的护理质量。方法 使用自行设计的《PTCA术后现状调查表》，对术后24h内的病人进行问卷调查，调查包括病人的年龄、性别及引起不舒适的各项因素并提出护埋对策。结果 术后病人平卧感觉不舒适的表现为：腰腱酸痛、睡眠差、焦虑、小便困难、穿刺产部位疼痛、胸闷、低血压、头晕。而导致不舒适的原因有“人”、“物”、“环境”、“方法”四方面的因素。结论 认为加强术前健康宣教，加深病人对所患疾病及导管手术的认识，消除紧张、恐惧心理，术后密切观察病情及时发现病情变化，良好的服务态度。从“人”、“物”、“环境”、“方法”四方面加以改善，是提高手术成功率，促进病人早日康复的重要保证。     

Investigation of relationships among gastroesophageal reflux disease subtypes using narrow band imaging magnifying endoscopy

AIM:To investigate the relationships among subtypes of gastroesophageal reflux disease(GERD)using narrow band imaging(NBI)magnifying endoscopy.METHODS:A reflux disease questionnaire was used to screen 120 patients representing the three subtypes of GERD(n=40 for each subtypes):nonerosive reflux disease(NERD),reflux esophagitis(RE)and Barrett’s esophagus(BE).NBI magnifying endoscopic procedure was performed on the patients as well as on 40 healthy controls.The demographic and clinical characteristics,and NBI magnifying endoscopic features,were recorded and compared among the groups.Targeted biopsy and histopathological examination were conducted if there were any abnormalities.SPSS 18.0 software was used for all statistical analysis.RESULTS:Compared with healthy controls,a significantly higher proportion of GERD patients had increased number of intrapapillary capillary loops(IPCLs)(78.3%vs 20%,P<0.05),presence of microerosions(41.7%vs 0%,P<0.05),and a non-round pit pattern below the squamocolumnar junction(88.3%vs 30%,P<0.05).The maximum(228±4.8 vs 144±4.7,P<0.05),minimum(171±3.8 vs 103±4.4,P<0.05),and average(199±3.9 vs 119±3.9,P<0.05)numbers of IPCLs/field were also significantly greater in GERD patients.However,comparison among groups of the three subtypes showed no significant differences or any linear trend,except that microerosions were present in 60%of the RE patients,but in only 35%and 30%of the NERD and BE patients,respectively(P<0.05).CONCLUSION:Patients with GERD,irrespective of subtype,have similar micro changes in the distal esophagus.The three forms of the disease are probably independent of each other.     

Effect of pronase as mucolytic agent on imaging quality of magnifying endoscopy

AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.     

Polyp detection rates using magnification with narrow band imaging and white light

AIM: To compare the yield of adenomas between narrow band imaging and white light when using high definition/magnification. METHODS: This prospective, non-randomized comparative study was performed at the endoscopy unit of veteran affairs medical center in Phoenix, Arizona. Consecutive patients undergoing first average risk colorectal cancer screening colonoscopy were selected. Two experienced gastroenterologists performed all the procedures that were blinded to each other's findings. Demographic details were recorded. Data are presented as mean ± SEM. Proportional data were compared using the χ2 test and means were compared using the Student's t test. Tandem colonoscopy was performed in a sequential and segmental fashion using one of 3 strategies: white light followed by narrow band imaging [Group A: white light(WL) → narrow band imaging(NBI)]; narrow band imaging followed by white light(Group B: NBI → WL) and, white light followed by white light(Group C: WL → WL). Detection rate of missed polyps and adenomas were evaluated in all three groups. RESULTS: Three hundred patients were studied(100 in each Group). Although the total time for the colonoscopy was similar in the 3 groups(23.8 ± 0.7, 22.2 ± 0.5 and 24.1 ± 0.7 min for Groups A, B and C, respectively), it reached statistical significance between Groups B and C(P 0.05). The cecal intubation time in Groups B and C was longer than for Group A(6.5 ± 0.4 min and 6.5 ± 0.4 min vs 4.9 ± 0.3 min; P 0.05). The withdrawal time for Groups A and C was longer than Group B(18.9 ± 0.7 min and 17.6 ± 0.6min vs 15.7 ± 0.4 min; P 0.05). Overall miss rate for polyps and adenomas detected in three groups during the second look was 18% and 17%, respectively(P = NS). Detection rate for polyps and adenomas after first look with white light was similar irrespective of the light used during the second look(WL → WL: 13.7% for polyps, 12.6% for adenomas; WL → NBI: 14.2% for polyps, 11.3% for adenomas). Miss rate of polyps and adenomas however was significantly higher when NBI was used first(29.3% and 30.3%, respectively; P 0.05). Most missed adenomas were ≤ 5 mm in size. There was only one advanced neoplasia(defined by size only) missed during the first look. CONCLUSION: Our data suggest that the tandem nature of the procedure rather than the optical techniques was associated with the detection of additional polyps' and adenomas.     

Esophageal squamous cell carcinoma - precursor lesions and early diagnosis

Squamous cell carcinoma of the esophagus (SCCE) carries a poor prognosis due to late diagnosis.Early detection is highly desirable,since surgical and endoscopic resection offers the only possible cure for esophageal cancer.Population screening should be undertaken in high risk areas,and in low or moderate risk areas for people with risk factors (alcoholics,smokers,mate drinkers,history of head and neck cancer,achalasia and lye stricture of the esophagus).Esophageal balloon cytology is an easy and inexpensive sampling technique,but the current methods are insufficient for primary screening due to sampling errors.Conventional endoscopy with biopsy remains the standard procedure for the identification of pre-malignant and early malignant changes in esophageal mucosa and endoscopic detection.It may be enhanced by several techniques such as dye and optic chromoendoscopy,magnifying endoscopy,and optical-based spectroscopic and imaging modalities.Since more than 80% of SCCE deaths occur in developing countries,where expensive techniques such as narrow band imaging (NBI) and autofluorescence imaging are unavailable,the most cost-effective tool for targeting biopsies may be Lugol dye chromoendoscopy,since it is easy,accurate,inexpensive and available worldwide.In ideal conditions,or in developed countries,is it reasonable to think that optimal detection will require a combination of techniques,such as the combination of Lugol’s chromoendoscopy and NBI to identify esophageal areas that require further characterization by a high resolution technique.The efficacy and cost-effectiveness will determine whether these modalities will become part of standard endoscopy practice.     

Magnifying narrow-band imaging with acetic acid to diagnose early colorectal cancer

AIM:To evaluate the diagnostic characteristics of magnifying endoscopy with acetic acid spray and narrowband imaging(MA-NBI)for early colorectal cancer.METHODS:We conducted a prospective study to evaluate the diagnostic characteristics of MA-NBI in differentiating early colorectal adenocarcinomas from adenomas.To compare the results,we used magnifying endoscopy with NBI(M-NBI)and magnifying endoscopy with crystal violet staining(M-CV).The study was performed in 2 phases.In phase 1,10 colonoscopists at our institution were shown still photographs of 35colorectal polyps(24 adenocarcinomas and 11 adenomas)in M-NBI,MA-NBI,and M-CV.They made diagnostic predictions using a five-grade scoring evaluation.We plotted receiver operating characteristic curves and compared the areas under the curves(AUCs).In phase2,colorectal polyps measuring≥8 mm were prospectively enrolled.During real-time colonoscopy,one ofthe 7 colonoscopists scored the lesion as an adenocarcinoma or an adenoma and assigned a level of confidence to the prediction(high or low).We calculated the accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)for each method and compared the proportions of highconfidence predictions.RESULTS:In phase 1,the mean±SD AUCs were 0.64±0.031 in M-NBI,0.71±0.066 in MA-NBI,and 0.76±0.059 in M-CV(P<0.05 for M-NBI vs MA-NBI,P<0.001 for M-NBI vs M-CV,and not significant for MANBI vs M-CV).In phase 2,84 patients with 91 lesions(46 adenocarcinomas and 45 adenomas)were enrolled.The diagnostic characteristics were as follows:73%accuracy,85%sensitivity,60%specificity,68%PPV,and 79%NPV in M-NBI;73%accuracy,80%sensitivity,64%specificity,70%PPV,and 76%NPV in MA-NBI;and 73%accuracy,83%sensitivity,62%specificity,69%PPV,and 78%NPV in M-CV.The proportions of high-confidence predictions were 57%in M-NBI,75%in MA-NBI,and 76%in M-CV(P<0.005 for M-NBI vs MA-NBI,P<0.0005 for M-NBI vs M-CV,and P=1.0 for MA-NBI vs M-CV).CONCLUSION:MA-NBI is useful for differentiating early colorectal adenocarcinomas from adenomas.     

Is it proper to use non‐magnified narrow‐band imaging for esophageal neoplasia screening? Japanese single‐center,prospective study

Aim: Most screening examinations in Japanese general hospitals are carried out by high‐definition television‐incompatible (non‐HD) scopes and non‐magnifying endoscopes. We evaluated the narrow‐band imaging (NBI) real‐time diagnostic yield of esophageal neoplasia in high‐risk patients at a general hospital. Methods: In a single‐center, prospective, non‐randomized controlled trial, 117 consecutive screening patients with high risk for esophageal cancer received primary white‐light imaging (WLI) followed by NBI and iodine‐staining endoscopy (59 by HDTV‐compatible [HD] endoscopy and 58 by non‐HD endoscopy). The primary aim was to evaluate the diagnostic yield of non‐magnified images in diagnosing esophageal neoplasia. The secondary aim was to compare HD endoscopy and non‐HD endoscopy in terms of diagnostic performance. Results: Overall, the sensitivity of NBI for screening of esophageal neoplasia was superior to WLI, and equivalent to iodine staining (92% vs 42%; P < 0.05, 92% vs 100%; ns). The specificity of NBI was equivalent to WLI (89% vs 94%; ns). In HD, NBI sensitivity was equivalent to both iodine staining and WLI (100% vs 75%; ns). In non‐HD, NBI sensitivity was equivalent to iodine staining, but WLI sensitivity was significantly inferior to NBI (88% vs 100%; ns, 25% vs 88%; P < 0.05). The NBI specificity was equivalent to WLI not only in HD but also in non‐HD (90% vs 96%; ns, 88% vs 93%; ns). Conclusion: In both HD and non‐HD endoscopy, NBI is less likely than WLI to miss a lesion. Even with non‐HD endoscopy, NBI is suitable for esophageal standard examinations in general hospitals.     

Impairment of secondary peristalsis in Barrett’s esophagus by transnasal endoscopy-based testing

AIM:To investigate dysfunctions in esophageal peristalsis and sensation in patients with Barrett’s esophagus following acid infusion using endoscopy-based testing.METHODS:First,physiological saline was infused into the esophagus of five healthy subjects,at a rate of 10 mL/min for 10 min,followed by infusion of HCl.Esophageal contractions were analyzed to determine whether the contractions observed by endoscopy and ultrasonography corresponded to the esophageal peristaltic waves diagnosed by manometry.Next,using nasal endoscopy,esophageal sensations and contractions were investigated in patients with,as well as controls without,Barrett’s esophagus using the same infusion protocol.RESULTS:All except one of the propulsive contractions identified endoscopically were recorded as secondary peristaltic waves by manometry.Patients with long segment Barrett’s esophagus(LSBE)tended to have a shorter lag time than the control group,although the difference did not reach statistical significance(88±54s vs 162±150 s respectively,P=0.14).Furthermore,patients with LSBE had significantly fewer secondary contractions following the infusion of both saline and HCl than did either the control group or patients with short segment Barrett’s esophagus(4.1±1.2 vs 8.0±2.8,P<0.001 and 7.3±3.2,P<0.01,respectively,following saline infusion;5.3±1.2vs 8.4±2.4 and 8.1±2.9 respectively,P<0.01 for both,following infusion of HCl).CONCLUSION:Using nasal endoscopy and a simple acid-perfusion study,we were able to demonstrate disorders in secondary peristalsis in patients with LSBE.     

内镜窄带成像技术在胃癌及癌前病变诊断中的应用

目的 探讨内镜窄带成像技术(NBI)对胃癌及癌前病变的诊断价值.方法 217例患者依次在普通内镜、NBI、0.2%靛胭脂染色及内镜放大(×80)模式下观察病变轮廓、胃小凹及微血管形态,评价各检查方法图像的清晰度,并结合病理学检查进行分析.结果 217例患者中,非萎缩性胃炎85例,萎缩性胃炎38例,轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例,进展期胃癌20例,伴有肠化生者91例.NBI对病变轮廓的显示明显优于普通内镜和靛胭脂染色(P值均=0.000).经内镜放大后,NBI对胃微血管形态的显示亦优于普通内镜和靛胭脂染色(P值均=0.000).NBI模式下萎缩性胃炎胃小凹主要表现为Ⅲ、Ⅳ、Ⅴ1型,肠化生主要表现为Ⅲ、Ⅳ、Ⅴ1、Ⅴ2型,异型增生主要表现为Ⅴ1型及Ⅳ型,胃癌主要表现为Ⅵ型.结论 NBI电子染色结合放大技术有助于提高胃癌及异型增生的活检准确率和早期胃癌检出率.     

Quality of life after three kinds of esophagectomy for cancer

AIM:To evaluate quality of life(QOL) following Ivor Lewis,left transthoracic,and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.METHODS:Ninety patients with esophageal cancer were assigned to Ivor Lewis(n = 30),combined thoracoscopic/laparoscopic(n = 30),and left transthoracic(n = 30) esophagectomy groups.The QOL-core 30 questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer,both developed by the European Organization for Research and Treatment of Cancer,were used to evaluate patients' QOL from 1 wk before to 24 wk after surgery.RESULTS:A total of 324 questionnaires were collected from 90 patients;36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits.QOL declined markedly in all patients at 1 wk postoperatively:preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis,combined thoracoscopic/laparoscopic,and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1(P 0.001),81.1 ± 9.0 vs 53.3 ± 11.5(P 0.001),and 83.6 ± 11.2 vs 46.4 ± 11.3(P 0.001),respectively.Thereafter,QOL recovered gradually in all patients.Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL;global scores were lower in this group than in the combined thoracoscopic/laparoscopic(P 0.001) and left transthoracic(P 0.001) groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively.QOL declined least in patients undergoing combined thoracoscopic/laparoscopic esophagectomy,and most indices had recovered to preoperative levels at 24 wk postoperatively.In the Ivor Lewis and combined thoracoscopic/laparoscopic groups,pain and physical function scores were 78.9 ± 18.5 vs 57.8 ± 19.9(P 0.001) and 59.3 ± 16.1 vs 70.2 ± 19.2(P = 0.02),respectively,at 1 wk postoperatively and 26.1 ± 28.6 vs 9.5 ± 15.6(P = 0.007) and 88.4 ± 10.5 vs 95.8 ± 7.3(P = 0.003),respectively,at 24 wk postoperatively.Scores in the left transthoracic esophagectomy group fell between those of the other two groups.CONCLUSION:Compared with Ivor Lewis and left transthoracic esophagectomies,combined thoracoscopic/laparoscopic esophagectomy enables higher postoperative QOL,making it a preferable surgical approach for esophageal cancer.     

Three-dimensional vs two-dimensional video assisted thoracoscopic esophagectomy for patients with esophageal cancer

AIM: To define the benefits of three-dimensional video-assisted thoracoscopic esophagectomy(3D-VATE)over 2D-VATE for esophageal cancer.METHODS: A total of 93 patients with esophageal cancer including 45 patients receiving 3D-VATE and48 receiving 2D-VATE were evaluated. Data related to patient and cancer characteristics, operating time,intraoperative bleeding, morbidity and mortality,postoperative inflammatory markers, Numerical Rating Scale for postoperative pain, Constant-Murley rating system for shoulder recovery and oxygenation index(OI) were collected. All medical records were retrieved from a prospectively maintained oncological database at our institution. A retrospective study was performed to compare the short-term surgical outcomes between the two groups.RESULTS: No significant differences were found between the two groups in either morbidity or mortality(P = 0.328). An enhanced surgical recovery was noted in the 3D group as indicated by shortened thoracoscopic operation time(3D vs 2D: 68 ± 13.79 min vs 83 ± 13min, P 0.01), minor intraoperative blood loss(3D vs 2D: 68.2 ± 10.7 ml vs 89.8 ± 10.4 ml, P 0.01),earlier chest tube removal(3D vs 2D: 2.67 ± 1.01 vs3.75 ± 1.15 d, P 0.01), shorter length of hospital stay(3D vs 2D: 9.07 ± 2.00 vs 10.85 ± 3.40 d, P 0.01), lower in-hospital expenses(3D vs 2D: 74968.4± 9637.8 vs 86211.1 ± 8519.7 RMB, P 0.01), lower pain intensity(P 0.01) and faster recovery of the left shoulder function(P 0.01). Better preservation of the pulmonary function was also found in the 3D group as the decline of the OI post operation was significantly lower than that of the 2D group(P 0.01). Changes of postoperative inflammatory markers, including procalcitonin [postoperative days(PODs) 4 and 7: P 0.01], peripheral granulocytes(PODs 1, 4 and 7: P 0.01) and hypersensitive C-reactive protein(POD 4: P 0.01) in 3D-VATE patients were less than those in the 2D group. Moreover, utilization of the 3D technique extended the dissection of the thoracic lymph nodes(P 0.01), with better exposure of nodes in the left recurrent laryngeal nerve(P = 0.031).CONCLUSION: 3D-VATE could be a more viable technique over 2D-VATE in terms of short-term outcomes for patients with esophageal cancer.