侧卧位腔镜全系膜食管癌根治术护理配合

The impact of surgical nursing on the post-operative outcome of patients with esphargeal cancer underwent thoracscopic esophagectomy in lateral position

目的总结侧卧位腔镜全系膜食管癌根治术的手术护理配合要点。方法回顾性分析2014年1月至2018年2月,福建医科大学附属协和医院完成侧卧位腔镜全系膜食管癌根治术患者653例,由手术室专科护士进行术前护理(术前患者准备、手术间及用物准备)及术中配合(体位摆放、生命体征检测、器械设备调整、胸腔镜手术操作与配合、腹腔镜手术操作与配合、颈部手术配合)。统计手术相关指标(手术时间、术中出血量、淋巴结清扫个数);术后恢复指标(术后拔胸管时间、术后进半流质时间、术后并发症)及手术前后血清转化生长因子β1(transforming growth factor-β1,TGF-β1);血管内皮生长因子(vascular endothelial growth factor,VEGF)水平。结果患者均顺利完成手术,无中转开胸或中转开腹患者,手术时间(290.22±43.80)min,术中出血量(132.24±100.13)ml,淋巴结清扫(30.84±8.80)枚,术后拔胸管时间(3.83±2.52)d,术后进半流质时间(11.64±4.90)d,术后肺部感染68例(10.41%),吻合口瘘17例(2.60%)。术前和术后TGF-β1分别为(45.18±7.15)μg/L和(20.05±11.40)μg/L,VEGF分别为(380.60±95.68)ng/L和(122.80±74.80)ng/L,差异有统计学意义(t=11.225、30.639,P<0.01)。结论手术护理配合侧卧位腔镜全系膜食管癌根治术,提高手术成功率及手术效率,缩短手术时间,术后未出现严重并发症,患者术后恢复良好。

Objective To discuss the impact of surgical nursing on the outcome of patients with esophageal cancer underwent thoracscopic esophagectomy in lateral position.Methods A retrospective analysis was performed on clinical data of 653 patients with esophageal cancer underwent thoracscopic esophagectomy in lateral position from January 2014 to February 2018 in Fujian Medical University Affiliated Union Hospital.Perioperative nurses worked on preoperative preparation,cooperation during the surgery,recording the surgical procedure related indicators(surgery time,intraoperative blood loss,lymph node dissection),postoperative recovery index(postoperative chest tube removal,semi-liquid diet and complications),and changes of serum levels of transforming growth factor-β1(TGF-β1)as well as vascular endothelial growth factor(VEGF)pre and post surgery.Results The surgical procedures went well for all patients,with no case being transferred to open surgery.The surgical procedure lasted for(290.20±43.80)min with(132.24±100.13)ml blood loss and(30.84±8.80)lymph nodes being removed during surgery.After the surgery,it took(3.83±2.52)days for chest tube being removed and(11.64±4.90)days for patients having semi-fluid diet.68 cases(10.41%)had pulmonary infection and 17 cases(2.60%)had anastomotic leakage.The serum levels of TGF-β1 and VEGF decreased from(45.18±7.15)μg/L to(20.05±11.40)μg/L and from(380.60±95.68)ng/L to(122.80±74.80)ng/L after the surgery,the differences were statistically significant(t=11.225、30.639,P<0.01).Conclusions The operation in lateral position for patients with esophageal cancer underwent thoracscopic esophagectomy is a minimally invasive,safe and reliable treatment.Surgical cooperation and nursing by perioperative nurses play an important role in the clinical outcomes of patients.