快速康复外科理念在胸腔镜联合腹腔镜食管癌切除术患者中的应用

Application of the fast track surgery concept in patients undergoing thoracoscopic and laparoscopic resection of esophageal carcinoma

目的探讨快速康复外科(FTS)理念在胸腔镜联合腹腔镜(简称胸腹腔镜)食管癌切除术患者中的应用效果。方法以东莞市人民医院心胸外科2015年2月至2017年2月收治的90例食管癌患者为研究对象,按入院单双号随机将患者分为观察组与对照组各45例,观察组行胸腹腔镜食管癌切除术+FTS,对照组则行胸腹腔镜食管癌切除术+传统管理,比较两组患者的手术相关指标、围术期应激指标、情绪状态及术后并发症情况。结果观察组术中出血量、术后引流量、术后排气时间、胸腔引流拔除时间、住院时间均明显少于对照组,差异均有统计学意义(P<0.05);观察组患者术后第1天、第5天C反应蛋白(CRP)、空腹血糖(FBG)、皮质醇(Cor)水平均明显低于对照组,差异均有统计学意义(P<0.05);观察组和对照患者术后SAS评分[(30.25±4.58)分vs(37.04±5.06)分]、SDS评分[(26.53±4.07)分vs(34.16±4.32)分]比较,观察组低于对照组,差异均有统计学意义(P<0.05);观察组术后肺部感染率为2.22%,明显低于对照组的17.78%,差异有统计学意义(P<0.05)。结论胸腹腔镜食管癌切除围术期应用FTS理念能明显减轻机体应激反应,缓解患者不良情绪,缩短住院时间,有利于其快速康复。

Objective To explore the application effect of the concept of fast track surgery （FTS） in patients un-dergoing thoracoscopic and laparoscopic resection of esophageal carcinoma. Methods A total of 90 patients with esopha-geal carcinomas, who admitted to Department of Cardiothoracic Surgery of the the People＇s Hospital of Dongguan Cityfrom February 2015 to February 2017, were selected and divided into the observation group and the control group accord-ing to random number table method, with 45 cases in each group. The observation group was treated with thoracoscopicand laparoscopic resection of esophageal carcinoma combined with FTS, while the control group was treated with thoraco-scopic and laparoscopic resection of esophageal carcinoma combined with conventional management. The operation relat-ed indicators, perioperative stress indicators, emotional state and postoperative complications were compared between thetwo groups. Results The intraoperative blood loss, postoperative drainage volume, postoperative exhaust time, the re-moval time of thoracic drainage tube and hospital stay of the observation group were significantly less or shorter thanthose of the control group （P〈0.05）. The levels of C reactive protein （CRP）, fasting blood glucose （FBG） and cortisol（Cor） in the observation group on the 1st and 5th day after operation were significantly lower than those in the controlgroup （P〈0.05）. There were significant differences between the two groups in SAS score and SDS score after opera-tion： （30.25±4.58） vs （37.04±5.06）, （26.53±4.07） vs （34.16±4.32）, P〈0.05. The incidence of postoperative pulmonaryinfection was 2.22% in the observation group versus 17.78% in the control group （P〈0.05）. Conclusion The applica-tion of the concept of FTS in perioperative period of thoracoscopic and laparoscopic resection of esophageal carcinomacan significantly relieve the stress response, alleviate the unhealthy emotions, shorten the hospital stay, and promotethe recovery of patients.