快速康复外科护理在胸腔镜肺癌根治术围术期中的应用效果

目的探讨快速康复外科护理在胸腔镜肺癌根治术围术期的应用效果。方法将72例接受胸腔镜肺癌根治术的患者随机分为2组,各36例。对照组围术期行常规护理,观察组应用快速康复外科护理。结果观察组患者术后肛门恢复排气时间、胸管留置时间和住院时间均短于对照组,术后并发症发生率和24 h及48 h的VAS评分均低于对照组,差异有统计学意义(P<0.05)。结论胸腔镜肺癌根治术围术期应用快速康复外科护理,能改善患者术后疼痛程度,减少术后并发症发生率,缩短术后康复进程。     

胸腔镜手术对非小细胞肺癌患者快速康复的效果评价

目的胸腔镜快速康复外科治疗非小细胞肺癌患者的临床应用及其效果评价,总结治疗经验。 方法回顾性分析海南医学院附属医院2011年10月至2013年10月经手术治疗的240例非小细胞肺癌患者的临床资料,其中经全胸腔镜手术170例(胸腔镜组),传统开胸手术者70例(传统开胸组)。比较两组患者的手术时间、术中失血量、术后胸液总量、胸引管带管时间,以及术后住院时间和并发症发生率;观察麻醉前(T0)、切皮后1 h(T1)、术毕(T2)、术后24 h(T3)和术后48 h(T4)的免疫应激状态相关指标。 结果两组均无围术期死亡病例,在出血量、手术时间、术后胸液总量、胸引管带管时间、术后住院时间方面胸腔镜组均优于传统开胸组,差异有统计学意义(t＝－11.0,P＝0.00;t＝－3.2,P＝0.00;t＝－12.7,P＝0.00;t＝－9.4,P＝0.00;t＝－6.0,P＝0.00);但两组患者的术后并发症发生率比较差异无统计学意义(χ²＝1.48,P＝0.22)。胸腔镜组在术后24 h(T3)和48 h(T4)的免疫因子指标高于传统开胸组,差异具有统计学意义(P<0.01)。在外周血中,胸腔镜组在术后24 h(T3)和48 h(T4)的去甲肾上腺素(NE)浓度低于传统开胸组,差异有统计学意义(t＝－11.81,P＝0.00;t＝－20.06,P＝0.00)。 结论胸腔镜外科治疗非小细胞肺癌具有手术时间短、出血量少,以及术后住院时间短、引流量少、应激和免疫反应小等优势,值得广泛应用。     

快速康复外科理念在胆总管结石患者围术期中的应用分析

目的 探讨快速康复外科(FTS)理念在胆总管结石患者围术期中应用的安全性及有效性,为快速康复外科理念在围手术期应用提供理论依据.方法 选择2009年6月～2011年12月在本院普外科住院,接受开腹外科手术治疗的胆总管结石患者86例,随机分为FTS组45例及对照组41例.对照组采用传统的围术期诊疗方法,FTS组采用快速康复的新型围术期干预措施;采集不同组间患者术后住院时间、输液总量、首次进食及排便时间、T管夹闭时间、术后白细胞恢复正常时间、肝功能恢复正常时间、切口拆线时间、住院费用及术后并发症发生率,统计分析两组间术后相关指标差异,以评估FTS在胆总管结石患者围手术期诊疗中应用的有效性及安全性.结果 FTS组的患者术后肛门排气及排便时间提前,术后胆汁丢失量、补液总量明显减少,术后白细胞恢复正常的时间、术后住院时间显著缩短,住院费用及术后并发症发生率明显较少,有统计学意义(P＜0.05).结论 在胆总管结石患者围术期治疗中应用FTS理念治疗安全、有效,对促进患者康复具有显著意义.     

快速康复外科在腹腔镜肝切除围手术期中的应用

[摘 要] 目的 探讨将快速康复外科（enhanced recovery after surgery,ERAS）策略应用于腹腔镜肝切除围手术期的临床效果。方法 采用回顾性队列研究方法,收集金华市中心医院2014年1月至2017年9月实施腹腔镜肝切除手术的190例患者资料,其中围术期采用ERAS处理策略的纳入ERAS组（n=60）,围术期采用传统处理策略的纳入对照组（n=130）,分析ERAS策略对患者手术时间、术中出血量、引流管留置时间、半流质饮食时间、住院费用等指标的影响。结果 两组在手术时间、术中出血量、术中输血、并发症发生率等方面,差异无统计学意义（P＜0.05）。与对照组比较,ERAS组术后第1、2、3天疼痛评分低（P=0.011、0.009、0.002）,留置胃管、尿管、腹腔引流管天数少（P＜0.001）,半流质饮食及肠道功能恢复天数早（P＜0.001）,术后住院天数及住院费用少（P=0.001、0.014）。结论 将ERAS策略应用于腹腔镜肝切除围手术期安全可行,可以减轻术后疼痛,减少腹腔引流管及术后半流质时间,降低住院费用,值得推广应用。     

快速康复外科在右半肝切除围手术期中的应用

目的 探讨快速康复外科（ERAS）模式应用于右半肝切除围手术期的临床价值。方法 分析2017年08月~2019年08月于我院进行右半肝切除术的53例患者临床资料,按围手术期的处理方法不同分为快速康复组（ERAS组）和传统对照组（对照组）。比较两组患者术前、术中的基本资料,及术后住院时间、肛门恢复排气时间、住院总费用、并发症、术后恢复质量（15项恢复质量评分量表,QoR-15）及C反应蛋白（CRP）等方面,评价其临床价值。结果 两组患者术前基本资料无统计学意义,具有可比性（P>0.05）;在手术时间、术中出血量方面两组比较无统计学差异（P>0.05）;两组患者在术后肛门恢复排气时间、住院时间、住院总费用、并发症方面比较差异有统计学意义（P均<0.05）;ERAS组在术后恢复质量评分高于对照组（P<0.05）,而在CRP方面ERAS组数值低于后者（P<0.05）。结论 在右半肝切除的围手术期应用加速康复外科模式能够有效地缩短住院时间,降低住院费用、术后并发症及术后创伤应激反应,从而促进患者的快速康复。     

原发性非小细胞肺癌侵及胸壁的外科治疗体会

目的 探讨原发性非小细胞肺癌侵及胸壁的外科治疗特点。方法 回顾性分析32例原发性非小细胞肺癌侵及胸壁外科治疗的临床资料。结果 32例患者中行胸膜肺切除28例，胸壁肺切除4例，其中2例行胸壁重建。术后并发血胸2例，脓胸1例，无手术死亡，术后随访1、3、5年生存率分别为71．9％（23／32）、42．3％（11／26）、28．6％（4／14）。结论 原发性非小细胞肺癌直接侵犯胸壁并非远处转移，治疗上应积极采取外科手术，并辅以其他方法的综合治疗。     

胸腔镜联合加速康复外科流程在肺癌手术中应用的临床研究

目的 评价胸腔镜联合加速康复外科(FTS)流程在肺癌手术中应用的可行性.方法 2006年1月至2010年12月对249例行肺癌根治手术的患者,分别应用后外侧小切口开胸肺切除(Ⅰ组)、单纯胸腔镜辅助开胸(Ⅱ组)、FTS联合胸腔镜辅助开胸(Ⅲ组)3种治疗模式,快速康复流程包括:有效宣教、有效镇痛、早期下床、早期拔管,对比3组患者临床指标.结果 3组均无手术死亡病例,Ⅱ、Ⅲ组与Ⅰ组相比,术中出血量明显降低、切口长度减少、术后曲马多针用量减少,但手术时间延长,以上各项差异均有统计学意义(P＜0.05);Ⅲ组与Ⅰ、Ⅱ组相比,术后下床时间、术后住院天数、胸管拔除时间明显缩短,术后曲马多针用量明显减少,术后并发症发生率明显降低,差异具有统计学意义(P＜0.05).结论 胸腔镜联合加速康复外科可缩短术后住院时间,加快肺癌患者术后康复.     

全胸腔镜肺叶切除术治疗临床早期非小细胞肺癌的疗效评价

目的探讨全胸腔镜肺叶切除术治疗临床早期肺癌的安全性和可行性,评价其手术疗效。方法回顾性分析2005年1月至2008年12月复旦大学附属中山医院160例(全胸腔镜手术组,其中男83例,女77例;平均年龄60.8岁)接受全胸腔镜肺叶切除术治疗的临床早期非小细胞肺癌患者的围手术期资料及生存数据,并与同期357例(开放手术组,其中男222例,女135例;平均年龄59.5岁)接受常规开放手术的早期非小细胞肺癌患者数据进行比较。结果全胸腔镜手术组患者中转开胸率为5.0%(8/160)。全胸腔镜组手术时间明显短于开放手术组(113.0 min vs.125.0 min,P=0.039);两组患者术后住院时间差异无统计学意义[(10.3±4.3)d vs.(9.1±4.6)d,P=0.425]。全胸腔镜手术组和开放手术组患者并发症发生率分别为9.4%(15/160)和10.1%(36/357),围术期死亡率为0.6%(1/160)和2.0%(7/357)。两组患者平均淋巴结清扫组数[(2.4±1.5)组vs.(2.4±1.7)组,P=0.743]和平均淋巴结清扫数[(9.8±6.3)枚vs.(10.1±6.4)枚,P=0.626]差异无统计学意义。全胸腔镜手术组总体5年生存率高于开放手术组(81.5%vs.67.8%,P=0.001)。进一步按不同病理分期进行亚组分析显示全胸腔镜手术组5年生存率为pⅠa期86.0%,pⅠb期84.5%,pⅢa期58.8%;开放手术组5年生存率为pⅠa期92.9%,pⅠb期76.4%,pⅢa期25.3%。结论全胸腔镜肺叶切除术治疗临床早期肺癌在技术上安全可行,其淋巴结清扫可达到开放手术的范围,远期疗效优于开放手术,但亟待大样本量的随机对照研究进一步证实。     

快速康复外科在胰十二指肠切除围手术期中的应用

快速康复外科(enhanced recovery after surgery,ERAS)理念已获得国内大部分外科医生认可,但围绕其实施和应用仍然存在诸多争议和质疑,本文结合1例胰十二指肠切除术的病例探讨ERAS理念用于胰十二指肠切除术的的临床适用性及安全性。     

胸腔镜复杂肺段切除术治疗Ⅰ期非小细胞肺癌的围手术期效果

目的 评价胸腔镜复杂肺段切除术治疗Ⅰ期非小细胞肺癌的效果.方法 从2017年1月至2020年3月在我院接受胸腔镜下肺段切除术的Ⅰ期非小细胞肺癌患者中筛选出行胸腔镜复杂肺段切除术患者58例(复杂肺段切除术组)和行胸腔镜优势肺段切除术患者33例(优势肺段切除术组).91例患者中,男36例、女55例,中位年龄57(50 ～ ...     

非小细胞肺癌术后随访中国胸外科专家共识

外科手术是非小细胞肺癌的重要治疗手段,其术后定期随访是早期发现和治疗肿瘤复发转移或第二原发肿瘤的有效方法,可提高患者的生活质量,改善预后.本共识旨在完善我国非小细胞肺癌患者术后随访方案,为负责非小细胞肺癌患者术后随访的同道提供参考,进一步提高我国肺癌规范化诊疗水平.     

单操作孔完全胸腔镜非小细胞肺癌根治术

目的总结单操作孔完全胸腔镜手术行非小细胞肺癌根治术中的经验。方法行单操作孔全胸腔镜下肺癌根治术60例,右上肺叶切除19例,右肺中叶切除4例,右下肺叶切除20例。左上肺叶切除12例,左肺下叶切除5例。胸腔镜观察孔取腋中线第7肋间,做2 cm左右切口,操作孔根据病灶部位选择第4或5肋间取腋前线至腋中线间,切口长约4~5 cm,经单操作孔完成肺癌根治术。结果全组患者手术顺利,无围手术期死亡患者,无严重术后并发症。清扫淋巴结平均(12.5±2.1)枚。平均手术时间(185.2±10.4)分钟。术中出血平均(150.5±30.6)ml。胸腔引流管拔除时间平均(3.5±1.5)天。术后住院时间平均(5.5±1.2)天。结论和传统腔镜手术比较,单操作孔减少了背部伤口,进一步减小创伤。单操作孔完全胸腔镜手术常规胸腔镜器械可完成,不需增加特殊器械。患者选择恰当并且按正确顺序操作,是单操作孔胸腔镜手术成功的重要保证。     

机器人与胸腔镜肺叶切除对非小细胞肺癌患者机体创伤及淋巴细胞亚群的影响

目的 探讨机器人与胸腔镜肺叶切除对非小细胞肺癌患者机体创伤及淋巴细胞亚群的影响.方法 收集本中心同时期同一手术组进行肺叶切除120例非小细胞肺癌患者的临床资料.根据手术方式不同,将患者分为机器人组(n=60)和胸腔镜组(n=60).记录两组患者手术时间、术中出血量、术后引流时间、引流量、术后住院时间、并发症发生率、疼痛...     

加速康复外科理念在口腔癌患者围术期护理中的应用

目的 探讨加速康复外科理念在促进口腔癌患者康复中的有效性及安全性.方法 将128例头颈外科口腔癌患者按入院时间分为常规组和FTS组,各64例.两组均给予常规护理,FTS组在此基础上采取缩短术前禁食禁饮时间、术中主动保温及限制性输液、术后及早进食及活动,尽早拔除各种管道,术后积极镇痛等措施.结果 两组患者术后并发症(除呕吐外)与住院时间、输液时间、住院费用及患者满意度比较,差异有统计学意义(P＜0.05,P＜0.01).结论 加速康复外科理念护理可保证口腔癌围术期患者治疗的安全性与有效性,缩短患者住院时间,促进患者康复.     

Serum clara cell protein levels in lung cancer patients: An assessment of preoperative values and postoperative changes

Serum levels of protein 1 (P1), a Clara cell protein known to have an antiinflammatory effect, were studied in 33 patients with lung cancer before surgery, and 3, 7, 14, 21 days, and 2 months after surgery. The preoperativeP1 values of the lung cancer patients were compared with those of 66 healthy controls matched by sex and age. The postoperative changes in P1 which occurred in the lung cancer patients were compared with those in 16 patients who underwent laparotomy for gastric or colon cancer. There was no significant difference in the P1 values between the lung cancer patients and the healthy controls; however, the postoperativeP1 values showed a significant decrease 3, 7, (P<0.001), and 14 days (P <0.05) postoperatively, recovering to normal within 2 months after surgery. One patient who died of postoperative pneumonia showed decreasing serum P1 levels until death. None of the laparotomy patients showed any decrease inP1 serum levels. Thus, we conclude that: (a) serumP1 levels do not differ between lung cancer patients and healthy individuals; (b) serumP1 levels significantly decrease in the early postoperative period, but recover within 2 months after lung resection; and (c) the postoperative changes that occur in serumP1 levels could provide important information about recovery from intraoperative lung damage.     

Prognostic value of FDG uptake in early stage non-small cell lung cancer

Background: Non-small cell lung cancer (NSCLC) has a poor prognosis even for early stages of the disease (stage I and II). We studied the prognostic value of PET FDG in patients with completely resected stage I and II NSCLC. Methods: Retrospective study of 96 patients with NSCLC whose staging included ¹⁸F-FDG PET (fluoro deoxy glucose positron emission tomography). Histopathological stage was either stage I (75) or stage II (n = 21). FDG uptake was measured as maximal standardized uptake value for body weight (SUVmax). Mean follow-up was 45 ± 30 months (1–142 months). Overall and cancer-free survival rates were recorded. Results: SUVmax were higher for stage II than for stage I (10.5 ± 4.5 vs 8.5 ± 5, p = 0.04). Mean tumor volumes were equivalent for both stages (33 cm³, p = 0.18), excluding a partial volume effect. The median SUVmax in the whole study population was 7.8. The median survival was significantly longer in patients with a lower (SUVmax ≤ 7.8) FDG uptake (127 months vs 69 months, p = 0.001). For stage I tumors (n = 75), high FDG uptake was significantly associated with reduced median survival: 127 months if SUVmax ≤ 7.8 and 69 months if SUVmax > 7.8 (p = 0.001). For stage II tumors (n = 21), no statistical difference was observed: 72 months vs 40 months for SUVmax ≤ 7.8 and for SUVmax > 7.8, respectively (p = 0.11), although there was a clear trend towards reduced survival for highly metabolic tumors. Disease-free survival was also significantly better for lower metabolic tumors: 96.1 months vs 87.7 months (p = 0.01). Conclusion: High FDG uptake is associated with reduced overall survival and disease-free survival of patients with completely resected stage I–II NSCLC. Whether patients with highly metabolic tumors should undergo a closer postoperative surveillance or adjuvant chemotherapy has to be addressed in a properly designed prospective trial.     

Video-assisted lobectomy in elderly lung cancer patients

OBJECTIVES: We evaluated the pre-, intra- and postoperative outcome of video-assisted thoracic surgery lobectomy in elderly lung cancer patients to determine what factors may be disadvantageous. METHODS: From June 1982 to May 2000, 707 patients underwent pulmonary resection for primary lung cancer. Of these, 87 patients with t1-2 peripheral lung cancer underwent lobectomy and postoperative pulmonary function tests and postoperative conditions at an average of 2.3 months postoperatively. Of these, 52 underwent video-assisted thoracic surgery lobectomy since 1994 and 35 lobectomy by standard thoracotomy. RESULTS: Video-assisted thoracic surgery lobectomy offered advantages in blood loss, chest wall damage, and minimal performance deterioration status. The percent vital capacity, percent forced expiratory in 1 second, and percent maximum ventilatory volume were well preserved in patients who underwent video-assisted thoracic surgery lobectomy. Multivariate logistic regression analysis identified operation duration as an independent risk factor in morbidity and operative procedure as an independent risk factor in performance deterioration. In stage IA and IB patients, 3-year-survival was 92.9% and 5-year survival 53.8% in those undergoing lobectomy by standard thoracotomy and 84.2% at 3 years and 60.1% at 5-years in those undergoing video-assisted thoracic surgery lobectomy. CONCLUSION: We thus consider video-assisted thoracic surgery lobectomy in this age group to be an effective procedure, but the long surgical duration is a risk factor in a poor clinical outcome.     

Intrathoracic light-assisted anterior limited thoracotomy in lung cancer surgery

We recently developed an intrathoracic lightassisted anterior limitted thoracotomy (ILAALT) for use in lung cancer surgery. A skin incision 12 cm long is made below the breast, then the pectoral major muscle is divided, and the fourth intercostal space is opened with a disconnection of the anterior cartilagenous portion. The posterior skin, including the serratus anterior muscle, is drawn posteriorly using a retractor. To illuminate the posterior and apex portions of the thoracic cavity, a flexible fiber light is introduced into the thoracic cavity through the eighth intercostal space at the posterior axillary line. These techniques provided adequate exposure and sufficient illumination in the thoracic cavity, thus making surgery easy for most thoracic applications. Using this approach, we undertook 28 lung resections with a mediastinal nodal dissection for lung cancer (24 lobectomies, 2 bilobectomies, and 2 pneumonectomies) without difficulty. The mean intrasurgical blood loss was 217 ml, the operative time 262 min, and chest tube drainage duration 2.3 days. Except for one case, no patients required a blood transfusion. All patients underwent continuous epidural anesthesia until postoperative day (POD) 8. The mean time that other analgesic medication was required was 0.5 times per patient until POD 13, but none from POD 14 on. We thus conclude ILAALT to be low-invasive thoracotomy and is thus indicated for most types of lung cancer surgery, providing a reduction of pain as its main advantage.     

Prognostic value of visceral pleura invasion in non-small cell lung cancer

Objectives: The purpose of this study was to clarify the prognostic significance of visceral pleura invasion in T2 non-small cell lung cancer (NSCLC). Materials and methods: Between 1990 and 2001, 439 consecutive patients with T2 NSCLC underwent curative surgical resection. The subjects included 234 patients with stage IB, 95 with stage IIB, and 110 with stage IIIA and B disease. The patients were divided into two groups according to the existence of visceral pleura invasion (group I without, group II with). Both groups were compared with regard to tumor size, histology, associated mediastinal lymph node involvement, and survival rates. Results: Visceral pleura invasion (group II) was identified in 114 patients (26%), and was present in 22% of patients with NSCLC with a tumor size of 3 cm or less and in 27% of those with a tumor larger than 3 cm (P=0.37). Visceral pleura invasion was associated with a higher frequency of mediastinal lymph node involvement (group I=22%, group II=34%, P=0.009). Five- and 10-year survival rates were 50 and 45% in group I, and 36 and 22% in group II (P=0.0006). In stage IB, visceral pleura invasion was identified in 53 patients (23%), and 5- and 10-year survival rates were 63 and 60% in the visceral pleura non-invasion group, and 44 and 28% in visceral pleura invasion group (P=0.0018). By multivariate Cox model analysis, age at intervention (relative RISK=1.03, P=0.0017), N status (relative RISK=1.53, P<0.0001), tumor size (relative RISK=1.83, P=0.0452) and visceral pleura invasion (relative RISK=1.42, P=0.0291) were independent predictors of poor prognosis. Conclusions: We were able to demonstrate that visceral pleura invasion was a factor of poor prognosis in T2 NSCLC. It was found to correlate with more extensive mediastinal lymph node involvement and a decreased survival rates. Therefore, the patients with visceral pleura invasion should be closely followed up especially.     

Progress in lung cancer: Non-oat cell (non-small cell lung cancer)

Lung cancer remains the greatest killing cancer in the United States with 149,000 new cases expected in 1987. The present expected mortality rate is 87 per cent. More women in the United States died of lung cancer than breast cancer in 1986. Asymptomatic, early and curable lung cancer in high risk individuals is usually found by routine chest X-ray. So-called Stage I lung cancer was reported to have a 83 per cent survival rate at three years by Martini and Beattie in 1977 and 70 per cent five year survival rate subsequently. When the more than 30,000 volunteer males were enrolled in the National Cancer Institute, national lung program for screening, 223 unsuspected lung cancers were found. 47 per cent were Stage I with a survival rate at five years of over 76 per cent. The PMI-Strang/Memorial Sloan Kettering Cancer Center study found 53 cancers in its first screen and 235 lung cancers over the next eight years of the study. Forty per cent were Stage I with a five year survival rate of 70 per cent. Sputum cytology as compared to chest X-ray was of little additional value. Studies (Martini) of N1 lung cancer was found to have a 49 per cent survival rate following resection. The N2 group of lung cancers where the mediastinal tumor was surgically removable and followed by external radiation therapy had a 27 per cent survival rate at five years. Those tumors with solitary brain metastases where the solitary brain metastasis could be resected and the primary tumor controlled, gave a 27 per cent survival rate at six years. The group of advanced N2 disease where the mediastinum could not be completely cleared were a serious group of cancers. A study of 100 patients treated from 1977 to 1980 with surgery plus internal radiotherapy followed by external radiotherapy had an overall 22 per cent survival rate for four to eight years with most of the deaths occurring because of metastases outside the chest. More recently chemotherapy has been used pre-operatively for those individuals with advanced lung cancer in the chest then followed by a combination of surgery, internal radiotherapy, external radiotherapy and more chemotherapy, if chemotherapy sensitive. This is the so-called multidisciplinary approach. In our present early studies it seems that those so treated who are chemotherapy sensitive have a 44 per cent, two year survival rate in a group of patients considered to have extremely poor prognosis. Director Kriser Lung Cancer Center, Chief Thoracic Surgery, Director Clinical Cancer Programs, Beth Israel Medical Center Chief Medical Officer Emeritus, Attending Surgeon, Member of Board of Overseers, Memorial-Sloan-Kettering Cancer Center This report is the gist of a paper read by E.J.B. at the 87th Annual Congress of the Japanese Surgical Society, Tokyo, Japan, 1987.