快速康复食管癌外科的麻醉管理

目的探讨快速康复食管癌外科的麻醉管理。比较静脉全麻加硬膜外阻滞与单纯静脉全麻两种麻醉方法对应激反应的抑制效果及对术后康复效果的影响。方法年龄≤70岁、ASA分级Ⅰ～Ⅱ级、无严重合并症的择期食管癌手术患者160例，按信封法分为静脉全麻加硬膜外阻滞组（研究组）和单纯静脉全麻组（对照组），每组各80例。分别监测麻醉诱导前（T0）、麻醉诱导插管后（T1）、切皮后（T2）、术毕拔管后（T1）血压、心率的变化，麻醉维持用药量，术毕麻醉恢复情况，术后情况。结果T1～B对照组的收缩压、舒张压及心率均高于研究组（P〈0．05或〈0．01）。研究组普鲁泊福、维库溴铵、瑞芬太尼用药量[（580．52±102．71）、（12．19±3．22）、（1．31±0．15）mg]均显著少于对照组[（845．28±155．23）、（20．71±2．59）、（2．54±0．08）mg]（P〈0．05）。研究组术毕自主呼吸恢复时间、指令睁眼时间、拔管时问、定向力恢复时间均明显短于对照组（P〈0．05或〈0．01）。研究组术后首次排气时间、首次排便时间、住院时间、术后并发症发生率及住院总费用均优于对照组（p〈0．05）。结论静脉全麻加硬膜外阻滞能较好地抑制手术中的应激反应，减少麻醉药物用量，术后苏醒迅速，躁动发生率降低，术后首次排气、排便时间缩短，并发症减少，住院时间及住院总费用降低，有利于患者术后恢复。

全程化护理模式在胸外科食管癌手术患者中的应用方法及效果

探究对经历过胸外科食管癌手术的患者在术后实施全程化护理模式干预的具体方法以及其应用价值。方法 本次研究对象设定为在2020年12月至2023年9月期间本院内经过食管癌手术并康复的60例患者,其选择中30例设定为观察组的研究对象,对其实施全程化护理模式干预;另外30例设定为对照组,对其实施常规护理模式。通过收集患者的临床资料并定期进行随访,客观地描述和解释两组患者的生活水平、出现并发症的概率、对所接受护理的满意程度、心理情绪化指标以及相关康复指标。结果 两组各项指标对比,观察组均优于对照组(P<0.05)有统计学意义。结论 在胸外科食管癌手术患者中,全程化护理模式具有积极的应用效果。通过采用该模式,能提高患者的生活质量,减少并发症的发生率,增强护理满意度,改善心理状况,并促进相关康复指标的达成。这为临床实践提供了重要的指导和借鉴。

食管癌外科的风险因素、评估及对策的思考

食管癌外科属于高风险专业学科,食管癌根治性切除重建术是外科领域相当普及和最具挑战性的手术之一,如何正确认识、评估和对待风险,采取相应的对策,从而降低和规避风险,一直是临床关注和研究的热点,也是目前临床工作中需要解决的问题。为此,本文结合临床工作实践,复习相关文献,试图对食管癌外科的风险因素、评估方法、风险分级及其防范对策进行初步思考和讨论,期望为今后制定一个科学、合理、实用的食管癌切除手术风险评分系统提供有益的参考。

影像组学和深度学习在食管外科治疗中的应用

食管癌是全世界最常见的恶性肿瘤之一,也是全球癌症死亡的第六大原因[1]。据统计,近年来食管癌的发病率正在不断增加,相应的死亡率也明显增加,给家庭和社会带来一定压力。目前治疗食管癌的主要手段为以手术为中心的综合治疗[2],其中影像学检查在食管癌的诊断、疗效评价等方面均发挥重要作用。电子计算机断层扫描(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)、正电子发射计算机断层扫描(positron emission computed tomography,PET)等检查可显示肿瘤的形态学特征,如部位、大小、密度等,但诊断灵敏性和特异性有限。目前影像组学及DL技术的发展,可以更好地指导食管癌的外科治疗。

改良一次性佰通胃管在食管癌快速康复外科患者术后的应用

目的：探讨改良一次性佰通胃管在食管癌快速康复外科患者术后的应用及护理。方法：选取我院2012年10月-2015年1月180例食管癌术后快速康复外科患者，随机等分为观察组与对照组，对照组术后放置常规的胸腔闭式引流管，执行胸腔闭式引流护理常规。观察组术毕除放置常规胸腔闭式引流管外，再放置1根改良一次性佰通胃管。结果：使用改良一次性佰通胃管组患者术后肺部并发症低于对照组，差异有统计学意义（P 〈0．05），但术后吻合口瘘及乳糜胸等并发症差异均无统计学意义；观察组首次下床时间早于对照组，平均住院日少于对照组，结果均有统计学意义（P 〈0．05）；两组患者术后疼痛程度观察组轻于对照组，结果有统计学意义（P 〈0．05）。结论：改良一次性佰通胃管的应用缩短了患者住院时间；降低了患者的疼痛程度，使其早期下床活动；减少了肺部并发症发生。

护理干预对高龄食管癌围术期心血管并发症的影响

目的探讨护理干预对高龄食管癌患者围术期并发心血管的影响。方法高龄食管癌患者围术期并发心血管病43例,分析原因制定相应护理干预措施。对高龄食管癌手前充分了解患者各重要器官的功能,并做好针对性的心理护理;术中密切观察生命体征,对其变化及时作出适当的处理;术后给予有效的术后护理干预。所获数据采用方差分析、t检验。结果治愈27例,好转8例,自动出院7例,未治1例。行根治术32例,行探查术10例,1例因严重肾功能不全家属放弃手术。手术前与手术后心率、收缩压及中心静脉压比较t=3.3266-4.7687,P〈0.01,有显著性差异。结论有效的护理干预可减少高龄食管癌患者围术期心血管并发症的发生。

人性化护理在食管癌护理中的应用效果

探究分析在胸外科食管癌手术患者中运用人性化护理模式产生的效果。方法:从本院收治的胸外科食管癌手术患者中随机抽取120例患者作为研究对象,将其随机分为两组,每组各60例患者,对照组患者使用常规护理模式,观察组患者使用人性化护理模式。结果:对照组患者出现术后并发症高于观察组(P<0.05);观察组患者手术日焦虑程度、术后疼痛程度、住院时间、治疗费用均低于对照组(P<0.05)。结论:将人性化护理模式应用在胸外科食管癌手术患者中,不仅能降低其并发症概率,还能有效改善患者的焦虑状态,在临床护理中具有较大的应用价值。

全程化护理模式在胸外科食管癌手术患者中的应用

探讨全程化护理模式在胸外科食管癌手术患者中的应用效果。方法:此次研究对象为我院胸外科近年来收治的120例食管癌手术患者,采用随机分配的方式,分为对照组和观察组,其中对照组采用常规护理,观察组采用全程化护理模式,分析比较两组患者的护理效果。结果:通过实验观察,比较两组患者的有关临床指标、术后并发症发生率及其护理满意度情况,观察组明显优于对照组,P<0.05具有统计学意义。结论:针对胸外科食管癌手术患者,采用全程化护理模式,能够明显减轻患者的焦虑情绪、减短患者的住院时间,减少住院费用,降低各种并发症的发生率,更加利于患者身体的快速恢复,具有一定临床推广价值。

食道癌术中结扎胸导管预防乳糜胸

目的 术中预防性结扎胸导管防止乳糜胸的发生。方法 收治 2 5 82例病人 ,A组 :不结扎胸导管。B组 :分离后结扎胸导管。C组 :大块组织缝扎胸导管。结果 B组和C组乳糜胸的发生率与A组相比有差异 (P <0 .0 1) ,C组乳糜胸的发生率低于B组 ,但无统计学差异 (P <0 .0 5 )。结论 术中预防性结扎胸导管对减少食管癌术后乳糜胸的发生有明显作用。

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

Increased N-terminal pro-brain natriuretic peptide level predicts atrial fibrillation after surgery for esophageal carcinoma

AIM: To evaluate the value of plasma N-terminal pro- brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma. METHODS: NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge. RESULTS: Postoperative AF occurred in 11 patients (7.7%). AF patients were significantly older (69.6 ± 12.2 years vs 63.4 ± 13.3 years, P = 0.031) than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3 ± 18.3 pg/mL vs 396.1 ± 42.6 pg/mL, P = 0.016). After adjustment for age, gender, chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008).CONCLUSION: An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.

SURGICAL TREATMENT OF MALIGNANT ESOPHAGEAL TUMORS IN PUMC HOSPITAL

To study how to prolong the postoperative survival time of the patients with malignant esophageal tumors. The clinical data of 1098 patients with malignant esophageal tumors from 1961 to 1992 were retrospectively analyzed. The deletion of fragile histamine triplet (FHIT) gene (a tumor suppressor gene) in 30 fresh esophageal samples obtained in 1996 was detected with PCR and RT PCR method. The resectability was raised gradually and the operative morbidity and mortality decreased year by year, but there was no significant improvement on the postoperative 5 year survival rate. Delayed diagnosis and irradical resection influenced the long term survival. The deletion of cDNA of FHIT gene was 64.2% in esophageal cancer and 20% in the resected margin of the cancer. We believe that high grade atypical hyperplasia in esophageal epithelium and deletion of FHIT gene in esophageal cancer and its resected margin are pathological and molecular markers for early diagnosis of esophageal cancer respectively, and the latter may be one of the molecular markers for the resection. Early diagnosis and treatment, radical resection, and postoperative nutritional support are very important for the improvement of the postoperative survival time of the patients.

The clinical features of thoracic stomach cancer after surgical treatment for esophageal carcinoma

Objective:Postoperative recurrence of esophageal carcinoma was the main factor that affect the patients' survival and quality of life.This study mainly investigated the clinical features of thoracic stomach cancer (TSC) after surgical treatment for esophageal carcinoma.Methods:We retrospectively reviewed 51 cases of postoperative TSC in our hospital (Henan Province Tumor Hospital,Zhengzhou,China).Results:The 51 (10.97%) of all 465 cases that underwent endoscope after surgical treatment for esophageal carcinoma in our hospital were TSCs.There were 13 cases with complicating anastomotic recurrence.The locations of 46 cases (90.2%) were the same as the primary cancer.The 48 cases were squamous cell carcinomas and 3 cases were adenocarcinomas after esophagectomy for esophageal carcinoma.Endoscopic manifestations were puffiness-infiltrating type at 39.2% (20/51),massive type at 15.7% (8/51),ulcerative type at 7.8% (4/51) and ulcerative infiltrating type at 3.9% (2/51) and stenotic type etc.Conclusion:The incidence of TSC after surgical treatment for esophageal carcinoma is high.The main cause was that the local residual cancer invaded gastric wall.The gastroscopic features of TSC are different from those of gastric cancer.Regular review with endoscopy in postoperative esophageal carcinoma patients was a major way to diagnose TSC.

Palliative cardia resection with gastroesophageal reconstruction for perforated carcinoma of the gastroesophageal junction

Iatrogenic perforation of esophageal cancer or cancer of the gastroesophageal(GE)junction is a serious complication that,in addition to short term morbidity and mortality,significantly compromises the success of any subsequent oncological therapy.Here,we present an 82-year-old man with iatrogenic perforation of adenocarcinoma of the GE junction.Immediate surgical intervention included palliative resection and GE reconstruction.In the case of iatrogenic tumor perforation, the primary goal should be adequate palliative(and not oncological)therapy.The different approaches for iatrogenic perforation,i.e.surgical versus endoscopic therapy are discussed.

全程化护理模式在胸外科食管癌手术患者中的应用

探讨全程化护理模式在胸外科食管癌手术患者中的应用。方法 2022年1月-2022年12月期间,纳入320例胸外科食管癌手术患者,结合护理方案差异进行分组,以常规护理为对照组,全程化护理模式纳入观察组。比较两组护理前后负面情绪、睡眠质量、疼痛评分、生活质量、满意度。结果 观察组上述各项指标均比对照组好,P<0.05。结论 全程化护理模式用于胸外科食管癌手术临床护理效果确切。