胸腔镜下快速康复外科流程在肺癌手术中的临床应用价值

【摘要】〓目的〓探讨胸腔镜下快速康复外科流程在肺癌手术中的临床应用价值。方法 选取2013年8月~2014年8月80例肺癌根治手术患者为研究对象,分为观察组和对照组,每组40例。观察组患者采取胸腔镜下快速康复外科流程模式治疗,对照组患者采取胸腔镜下开胸手术治疗。采用VAS评分对术后1 d、3 d、7 d、14 d受试者疼痛进行评分;统计受试者术后留置尿管时间、胸管保留时间、肛门排气时间、住院时间及并发症情况;检测受试者入院后1 d、3 d、7 d、10 d、14 d血清白细胞介素6(IL?鄄6)、肿瘤坏死因子α(TNF?鄄α)含量。结果 观察组患者的留置尿管时间、胸管保留时间为、肛门排气时间、住院时间均少于对照组时间(P值均<0.05)。观察组患者术后心血管疾病、切口感染、肺部感染发生率较对照组患者术后发生率较低(P<0.05)。术后3 d、7 d两组VAS评分均较术后1 d改善,且观察组VAS评分改善幅度大于对照组(P<0.05);术后14 d两组VAS评分无显著差异(P>0.05)。观察组和对照组术后1 d血清IL?鄄6和TNF?鄄α水平无统计学差异(P>0.05),但术后3 d、7 d、10 d、14 d,观察组IL?鄄6和TNF?鄄α水平明显低于同期对照组(P值均<0.01)。结论 对肺癌手术患者采取胸腔镜下快速康复外科流程治疗模式,可有效缩短患者术后拔管时间、住院时间,减轻患者的损伤程度和疼痛感,且术后并发症发生率较低,患者术后恢复快。

Clinical values of thoracoscopic surgical treatment combined with fast track surgery in lung cancer surgery

【Abstract】 Objective〓To evaluate effects of thoracoscopic surgical treatment combined with application of fast-track surgery principles on lung cancer surgery. Methods〓A total of 80 patients who underwent radical resection of pulmonary carcinoma between August 2013 and August 2014 were selected, and divided into observation group and control group with 40 patients in each group. The patients in observation group were treated through the application of fast-track surgery principles, while the controls were treated with thoracoscopic chest surgery. The pain recording at 1 d, 3 d, 7 d, and 14 d after operation was scored by visual analogue scale (VAS). The postoperative retention times of urinary catheter and chest tube,times to passage of gas by anus,lengths of stay,and incidence of complications were counted. And the serum interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) contents were assayed at 1 d, 3 d, 7 d, 10 d, and 14 d after admission. Results〓The patients of the observation group had shorter retention times of urinary catheter and chest tube, time to passage of gas by anus, and length of stay than those of the control group (all P<0.05). The patients of the observation group had lower incidence of postoperative cardiovascular diseases, postoperative infection, and pulmonary infection than that of the control group(P<0.05). The patient of both groups had improved VAS scores at 3 d and 7 d after the surgeries compared with those at 1 d after the surgeries,and the patients of the observation group had greater improving extents than those of the control group(P<0.05). The difference in VAS score at 14 d after the surgeries was statistically insignificant between the patients of the two groups (P>0.05). The differences in serum IL-6 and TNF-α levels at 1d after the operation were statistically insignificant between the patients of the observation group and control group (P>0.05), but the patients of the observation group had significantly lower serum IL-6 and TNF-α levels at 3 d,.7 d,.10 d,.and 14 d than those of the control group.(all P<0.01). Conclusion Thoracoscopic surgical treatment combined with rapid recovery in patients with lung cancer surgery can effectively shorten the postoperative extubation time and length of stay, lighten the degrees of injury and pain, with a lower postoperative complication incidence and faster postoperative recovery.