快速康复外科在早期非小细胞肺癌微创手术中临床应用

目的胸腔镜手术已成为治疗早期非小细胞肺癌的主要微创手术方法。本研究通过对快速康复外科(fast track surgery,FTS)与传统方法在早期非小细胞肺癌患者微创手术治疗的对比研究,探讨FTS在微创手术治疗早期非小细胞肺癌的临床应用价值。方法选取2017-09-01-2018-10-30温州市人民医院胸心外科70例早期非小细胞肺癌微创手术治疗患者为研究对象,根据不同治疗方式分为FTS组35例和传统康复组(对照组)35例。FTS组患者采用单孔胸腔镜下FTS理念治疗,对照组采用三孔胸腔镜及传统治疗方法,比较2组术后下床活动时间、留置胸管时间、术后疼痛程度、住院时间、住院费用和术后并发症等情况。结果2组患者均痊愈出院,FTS组术后下床活动时间为(14.8±4.4)h,较对照组(38.5±5.7)h缩短,P<0.001;FTS组留置胸管时间为3(2~4)d,较对照组7(6~9)d缩短,P<0.001;住院时间为(8.4±1.5)d,较对照组(11.8±1.6)d缩短,P=0.001;住院费用为4(3~5)万,较对照组6(5~7)万减少,P<0.001。术后24、48和72 h疼痛量化评级表(numeric pain rating scale,NPRS)评分法分别为2、3和3分,低于对照组的6、5和5分,差异均有统计学意义,均P<0.05。2组患者术后肺不张、肺漏气、肺部感染、心率失常和血栓等情况比较,差异无统计学意义,P>0.05。结论与传统方法比较,FTS治疗可有效缩短早期非小细胞肺癌患者术后拔管及住院时间,减轻患者的手术创伤和疼痛感,且减少了平均住院费用,具有显著的临床疗效。

Application of FTS in minimally invasive surgery of early non-small cell lung cancer

OBJECTIVE To explore the clinical value of FTS in the treatment of early non-small cell lung cancer with minimally invasive surgery.METHODS Totally 70 patients with early non-small cell lung cancer treated with minimally invasive surgery in the Department of Cardiac Surgery,People’s Hospital of Wenzhou,from Sep 1,2017 to Oct 10,2018,were divided into FTS group(35 cases,treated with a single-port thoracoscopic FTS concept)and traditional rehabilitation group(control group,35 cases,treated with three-hole thoracoscopic and traditional treatment methods).The postoperative activity time,chest tube indwelling time,postoperative pain level,hospital saty time,hospitalization coats and postoperative complication were compared between the two groups.RESULTS All patients were cured.The time of postoperative activity in the FTS group was(14.8±4.4)h,which was shorter than that of the control group(38.5±5.7)h,P<0.001;the time of indwelling chest tube was 3(2-4)d,which was shorter than that of the control group 7(6-9)d,P<0.001;the hospital stay was(8.4±1.5)d,which was shorter than the control group(11.8±1.6)d,P=0.001;the hospitalization cost was 4(3-5),which was lower than that of the control group 6(5-7),P<0.001.The 24 th,48 th and 72 th postoperative NPRS pain scores were 2,3 and 3,respectively,which were lower than the control group(6,5,5),the difference was statistically significant(P<0.05).There were no significant differences in postoperative atelectasis,lung leak,pulmonary infection,arrhythmia,and thrombosis between the two groups(P>0.05).CONCLUSION FTS applied to minimally invasive surgery for early non-small cell lung cancer,which can effectively shorten the time of extubation and hospital stay,reduces the patient’s surgical trauma and pain,and reduces the average hospitalization cost,It has a significant clinical effect.