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快速康复外科策略在胸腔镜联合腹腔镜食管癌切除颈部吻合术中的应用
何佳虹,董斌,郑国芳,李金河
0
(四川大学华西广安医院胸心外科,四川 广安 638000)
摘要:
目的 探讨胸腔镜联合腹腔镜食管癌切除颈部吻合术患者应用快速康复外科(Fast track surgery,FTS)策略的效果。方法 选取2016年2月~2017年2月我院收治的接受胸腔镜联合腹腔镜食管癌切除颈部吻合术患者84例,按照随机数字法将其分为观察组和对照组各42例,观察组围术期予以常规干预法,对照组围术期予以FTS策略,比较两组术中出血量、平均手术时间、清扫淋巴结量及术后补液量、通气时间、胸管与尿管保留时间、住院时间、免疫功能相关指标、应激反应指标、并发症情况及死亡率。结果 两组围手术期均无死亡病例,且术中出血量、清扫淋巴结量、术后尿管保留时间比较差异无统计学意义(P>0.05);对照组平均手术时间、术后补液量、通气时间、胸管保留时间、住院时间以及禁食时间均明显短于观察组(P<0.05);两组术前与术后第1d IgA、IgG、IgM比较差异无统计学意义(P>0.05),而对照组术后第7d IgA、IgG、IgM均显著高于观察组(P<0.05);两组术前CRP、空腹血糖、IL-6以及血浆皮质醇比较差异无统计学意义(P>0.05),对照组术后第7d CRP、空腹血糖、IL-6以及血浆皮质醇均显著高于观察组(P<0.05);观察组术后并发症总发生率33.33%,显著高于对照组的7.14%(P<0.05);Logistic多因素分析显示,未实施FTS策略、术后补液量少、通气时间短为住院时间长的影响因素(P<0.05)。结论 对接受胸腔镜联合腹腔镜食管癌切除颈部吻合术治疗患者采取快速康复外科策略,能缩短手术时间、术后通气时间、胸管保留时间以及住院时间,缓解应激反应,降低对机体免疫功能产生的影响,且并发症少,能促进患者术后尽早康复,值得临床推广应用。
关键词:  快速康复外科  胸腔镜  腹腔镜  食管癌  应用
DOI:
基金项目:四川省卫生厅科研课题(1003430)
The application of fast track surgery in patients undergoing thoracoscopic combined with laparoscopic resection of esophageal carcinoma and cervical anastomosis
HE Jiahong,DONG Bin,ZHENG Guofang,LI Jinhe
(Department of Cardiothoracic Surgery, West China Guang'an Hospital, Sichuan University, Chengdu 638000, China)
Abstract:
Objective To study the effect of fast track surgery (FTS) in patients undergoing thoracoscopic combined with laparoscopic resection of esophageal carcinoma and cervical anastomosis. Methods 84 patients undergoing thoracoscopic combined with laparoscopic resection of esophageal carcinoma and cervical anastomosis in our hospital from February 2016 to February 2017 were included in the study. By the random number method, they were divided into two groups, 42 cases in each group. A group was given routine intervention during perioperative period, while B group were given FTS during perioperative period. The intraoperative blood loss, average surgery time, number of dissected lymph nodes, postoperative fluid infusion volume, ventilation time, chest tube and urinary catheter retention time, hospitalization time, immune function related indexes, stress indexes, complications and mortality rate were compared between the two groups. Results There were no death cases and significant differences between the two groups in the intraoperative blood loss, number of dissected lymph nodes and postoperative urinary catheter retention time (P>0.05). The average surgery time, postoperative fluid infusion volume, ventilation time, chest tube retention time, hospitalization time and fasting time of B group were significantly shorter or less than those of A group (P<0.05). There were no significant differences in IgA, IgG and IgM between the two groups before surgery and on the 1stday after surgery (P<0.05) while those in B group on the 7th day after surgery were significantly higher than those in A group (P<0.05). There were no significant differences between two groups in CRP, fasting blood glucose, IL-6 and plasma cortisol (P>0.05), while those in B group on the 7thday after surgery were significantly higher than those in A group (P<0.05). The incidence of postoperative complications in B group was significantly higher than that in A group (33.33% vs 7.14%) (P<0.05). Logistic multivariate analysis showed that no FTS, postoperative little fluid infusion and short ventilation time were the risk factors for longer hospital stay (P<0.05). Conclusion The application of FTS in patients undergoing thoracoscopic combined with laparoscopic resection of esophageal carcinoma and cervical anastomosis can shorten the surgery time, postoperative ventilation time, chest tube retention time and hospitalization time, relieve stress response and reduce the effect on immune function, with few complications. It also can promote the early recovery of patients after surgery.
Key words:  Fast track surgery  Thoracoscopy  Laparoscopy  Esophageal carcinoma  Application

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