目的探讨不同切口手术联合加速康复外科(enhanced recovery after surgery,ERAS)理念指导下的呼吸功能训练在肺癌患者中的应用效果。方法选择2020年1月至2022年12月在苏州大学附属太仓医院择期行肺癌根治术的患者200例,随机分为4组,每...目的探讨不同切口手术联合加速康复外科(enhanced recovery after surgery,ERAS)理念指导下的呼吸功能训练在肺癌患者中的应用效果。方法选择2020年1月至2022年12月在苏州大学附属太仓医院择期行肺癌根治术的患者200例,随机分为4组,每组50例。A组接受单孔胸腔镜手术,术前ERAS宣教,呼吸训练器和常规呼吸功能训练;B组接受腋下肌肉非损伤性小切口手术,术前ERAS宣教,呼吸训练器和常规呼吸功能训练;C组接受腋下肌肉非损伤性小切口手术,术前常规宣教和常规呼吸功能训练;D组接受单孔胸腔镜手术,术前常规宣教和常规呼吸功能训练。比较4组患者术后恢复情况及术后疼痛评分。结果与其他3组相比,A组患者肺部并发症发生率降低,下床时间更早,置管时间、住院时间均缩短(P<0.05);与B组、C组相比,A组患者术后疼痛显著减轻(P<0.05)。与C组相比,B组患者肺部并发症发生率降低,下床时间、置管时间、住院时间缩短(P<0.05)。手术切口相同组间的术后疼痛差异无统计学意义。结论单孔胸腔镜肺癌手术联合ERAS理念指导下的呼吸功能训练可明显降低患者术后肺部并发症发生率,减轻术后疼痛,加速康复。展开更多
Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lu...Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.展开更多
目的:探讨经肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)在直肠癌吻合口复发再手术中的可行性及安全性。方法:回顾性收集2020年4月至2021年12月瑞金医院收治的5例直肠癌术后吻合口复发行腹腔镜辅助TaTME病人的临床...目的:探讨经肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)在直肠癌吻合口复发再手术中的可行性及安全性。方法:回顾性收集2020年4月至2021年12月瑞金医院收治的5例直肠癌术后吻合口复发行腹腔镜辅助TaTME病人的临床资料。分析病人围术期情况、病理检查结果和近期随访。结果:5例均顺利完成腹腔镜辅助TaTME手术。手术时间(206.00±19.49)min,无术中并发症发生,1例术中遭遇错误间隙。术后发生吻合口漏1例,吻合口狭窄1例。所有病人的切除标本均完整,无环周切缘阳性和远切缘阳性。中位随访(15.20±2.39)个月。1例病人出现排便功能障碍,无肿瘤复发、转移及肿瘤相关性死亡。结论:腹腔镜辅助TaTME对直肠癌术后吻合口复发再手术病人,提供了一种新型、安全有效的手术入路和切除方式,近期随访满意。展开更多
文摘目的探讨不同切口手术联合加速康复外科(enhanced recovery after surgery,ERAS)理念指导下的呼吸功能训练在肺癌患者中的应用效果。方法选择2020年1月至2022年12月在苏州大学附属太仓医院择期行肺癌根治术的患者200例,随机分为4组,每组50例。A组接受单孔胸腔镜手术,术前ERAS宣教,呼吸训练器和常规呼吸功能训练;B组接受腋下肌肉非损伤性小切口手术,术前ERAS宣教,呼吸训练器和常规呼吸功能训练;C组接受腋下肌肉非损伤性小切口手术,术前常规宣教和常规呼吸功能训练;D组接受单孔胸腔镜手术,术前常规宣教和常规呼吸功能训练。比较4组患者术后恢复情况及术后疼痛评分。结果与其他3组相比,A组患者肺部并发症发生率降低,下床时间更早,置管时间、住院时间均缩短(P<0.05);与B组、C组相比,A组患者术后疼痛显著减轻(P<0.05)。与C组相比,B组患者肺部并发症发生率降低,下床时间、置管时间、住院时间缩短(P<0.05)。手术切口相同组间的术后疼痛差异无统计学意义。结论单孔胸腔镜肺癌手术联合ERAS理念指导下的呼吸功能训练可明显降低患者术后肺部并发症发生率,减轻术后疼痛,加速康复。
文摘Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.
文摘目的:探讨经肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)在直肠癌吻合口复发再手术中的可行性及安全性。方法:回顾性收集2020年4月至2021年12月瑞金医院收治的5例直肠癌术后吻合口复发行腹腔镜辅助TaTME病人的临床资料。分析病人围术期情况、病理检查结果和近期随访。结果:5例均顺利完成腹腔镜辅助TaTME手术。手术时间(206.00±19.49)min,无术中并发症发生,1例术中遭遇错误间隙。术后发生吻合口漏1例,吻合口狭窄1例。所有病人的切除标本均完整,无环周切缘阳性和远切缘阳性。中位随访(15.20±2.39)个月。1例病人出现排便功能障碍,无肿瘤复发、转移及肿瘤相关性死亡。结论:腹腔镜辅助TaTME对直肠癌术后吻合口复发再手术病人,提供了一种新型、安全有效的手术入路和切除方式,近期随访满意。
