微创外科联合加速康复外科在食管癌围手术期的应用

Application of minimally invasive surgery combined with accelerated rehabilitation surgery in the perioperative period of esophageal cancer

目的探讨微创外科联合加速康复外科在食管癌围手术期的临床应用效果。方法收集海安市人民医院胸外科2020年1月至2021年6月胸腹腔镜食管癌围手术期采用加速康复管理的32例食管癌患者的临床资料。研究内容包括术前一般临床资料、术中及术后相关指标及随访情况。结果32例患者行微创食管癌手术并进行快速康复管理,术后均恢复迅速。所有患者中,男22例,女10例;年龄(66±9)岁;BMI为(20.9±2.6)kg/m^(2);有高血压病史者8例,糖尿病史者2例;肿瘤在食管上段7例,中段16例,下段9例;肿瘤长度(4.2±1.8)cm。手术时长(352.5±76.9)min,出血量(93.2±34.5)mL;清扫淋巴结(5±2)站,(18±7)枚;术后胸管留置时间(5.1±2.7)d,胸腔引流量(1256.2±685.9)mL。术后并发症情况:术后吻合口瘘3例;术后腹胀8例;肺部感染2例;乳糜胸1例;声嘶2例;术后病理分期Ⅰ期7例,Ⅱ期19例,Ⅲ期6例,Ⅳ期0例;术后住院(10.5±3.6)d;术后随访时间1~18个月,随访期间死亡1人。结论食管癌采取微创胸腹腔镜手术方式联合加速康复外科是一组安全有效的管理策略,该治疗模式有利于食管癌患者术后早期康复,缩短患者住院时间。

Objective To explore the clinical effects of a combination of minimally invasive surgery with accelerated rehabilitation surgery during the perioperative period for the treatment of esophageal cancer.Methods The clinical data of 32 patients with esophageal cancer under accelerated rehabilitation management during the perioperative period of thoracic and laparoscopic esophageal cancer from January 2020 to June 2021 in Department of Thoracic Surgery at Hai’an People’s Hospital were collected.The study included preoperative general clinical data,intraoperative and postoperative related indicators and follow-ups.Results The 32 patients underwent minimally invasive esophageal cancer surgery under rapid rehabilitation management,and all patients recovered quickly after surgery.In general,there were 22 male and 19 female,the age was(66±9)years,and the BMI was(20.9±2.6)kg/m^(2).There were 8 cases with history of hypertension and 2 cases with history of diabetes.The tumors were located in the upper segment of the esophagus in 7 cases,the middle section in 16 cases,and the lower part in 9 cases.The average length of the tumor was(4.2±1.8)cm.The operation time was(352.5±76.9)min and the amount of bleeding was(93.2±34.5)mL.Moreover,(5±2)stations and(18±7)pieces of lymph nodes underwent dissection.The average postoperative thoracic tube retention time was(5.1±2.7)D and the thoracic drainage volume was(1256.2±685.9)mL.Postoperative complications included anastomotic leakage in three cases,postoperative abdominal distension in eight cases,pulmonary infection in two cases,chylothorax in one case,and hoarseness in two cases.In terms of the postoperative pathological stages,7 cases were in stageⅠ,19 cases were in stageⅡ,6 cases were in stageⅢ,and no cases were in stageⅣ.Postoperative hospitalization was(10.5±3.6)days,the follow-up time was 1-18 months,and one person died during the follow-up period.Conclusion:Minimally invasive thoracoscopic and laparoscopic surgery combined with accelerated rehabilitation surgery is a safe and effective management strategy for the treatment of esophageal cancer.This method is conducive to swift postoperative rehabilitation and shorten hospital stays.