加速康复在胸段食管癌行胸腹腔镜微创手术中的应用

目的 评价加速康复对胸段食管癌行胸腹腔镜微创食管癌手术患者早期结果的影响.方法 回顾性分析从2012年1月至2016年6月本院胸外科住院诊断为胸段食管鳞癌,同一手术组行胸腹腔镜微创食管癌切除、胃食管左颈部吻合、二野淋巴结清扫术的患者.其中传统组从2012年1月至2014年12月,共156例;加速康复组从2015年1月至2016年6月,共93例.记录并分析患者围术期相关指标.结果 加速康复组与传统组在年龄、性别、BMI、合并症指数、ASA评分、肿瘤分段、病理分期中差异均无统计学意义;加速康复组术后疼痛评分明显低于传统组(第1天:5.13±1.16 vs.5.69±1.17,P=0.000;第3天:2.63±0.76 vs.2.86±0.78,P=0.032;第7天:1.82±0.71 vs.2.56±0.47,P=0.005);加速康复组肺炎发生率更低(7.5％vs.17.3％,P=0.030),骶尾部皮损更少(4.3％ vs.12.2％,P=0.038);两组间在肺不张、ARDS、再次气管插管、颈部吻合口瘘、房颤、二次手术中的发生率无明显差异;加速康复组的住院时间短于传统组[(13.89±7.36)d vs.(17.41±6.77)d,P=0.000].结论 对胸段食管癌行胸腹腔镜微创切除手术患者在围术期实施加速康复措施干预,可减轻术后疼痛、降低术后并发症、缩短住院时间.

Application of fast-track surgery in thoracoscopic and laparoscopic minimally invasive esophageal cancer operation for thoracic segment esophageal cancer

Objective To evaluate the influence of fast track surgery on the early outcomes of thoracoscopic and laparoscopic minimally invasive esophageal cancer operation for thoracic segment esophageal cancer.Methods The inpatients with thoracic segment esophageal squamous cancer in this hospital from January 2012 to June 2016 were retrospectively analyzed,who in the same operation group performed thoracoscopic and laparoscopic minimally invasive esophageal cancer resection,gastroesophageal left neck anastomosis and two-field lymphadenectomy.Among them,the conventional group had 156 cases from January 2012 to December 2014 and the fast track surgery group had 93 cases from January 2015 to June 2016.Their perioperative related indicators were recorded and analyzed.Results The age,sex,BMI,complications index,ASA score,tumor segment,pathological stage had no statistical difference between the fast track surgery group and conventional group;the postoperative pain score in the fast track surgery group was significantly lower than that in the conventional group(on 1 d:5.13±1.16 vs.5.69±1.17,P=0.000;on 3 d:2.63±0.76 vs.2.86±0.78,P=0.032;on 7 d:1.82±0.71 vs.2.56±0.47,P=0.005);the pneumonia occurrence rate in the fast track surgery group was much lower(7.5％ vs.17.3％,P=0.030) and sacrococcygeal skin injury was much less(4.3％ vs.12.2％,P=0.038);the occurrence rates of pulmonary atelectasi,ARDS,re-tracheal intubation,neck anastomosis fistula,atrial fibrillation and re-operation had no statistical difference between the two groups;the hospitalization stay time in the fast track surgery was shorter than that in the conventional group[(13.89 ±7.36)d vs.(17.41±6.77)d,P=0.000].Conclusion Implementing fast-track surgery measure intervention during perioperative period in the patients with thoracic segment esophageal cancer resection can alleviative postoperative pain,decreases postoperative complications and shortens the hospitalization length.