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Impact of thoracic paravertebral block and sufentanil on outcomes and postoperative cognitive dysfunction in thoracoscopic lung cancer surgery
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作者 Dan-Dan Wang Hong-Yu Wang +1 位作者 Yan Zhu Xi-Hua Lu 《World Journal of Psychiatry》 SCIE 2024年第6期894-903,共10页
BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(T... BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal analgesia.However,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain unclear.AIM To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.METHODS This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023.Patients receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,respectively.We compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after surgery.Serum levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after surgery.The Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after surgery.Adverse reactions were also recorded.RESULTS There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest and with cough(P<0.05).The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased(P<0.05).The TPVB group had lower VAS scores than the control group at 2,12,and 24 h after surgery(P<0.05).The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group(P<0.05).The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery(P<0.05).Both groups had elevated serum E,Ang Ⅱ,and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels,with better indices in the TPVB group(P<0.05).Marked elevations in serum levels of VEGF,TGF-β1,TNF-α,and S-100β were observed in both groups at 24 h after surgery,with lower levels in the TPVB group than in the control group(P<0.05).CONCLUSION TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC,enhances analgesic effects,reduces postoperative stress response,and inhibits postoperative increases in serum VEGF,TGF-β1,TNF-α,and S-100β levels.This scheme also reduced POCD and had a high safety profile. 展开更多
关键词 Thoracic paravertebral block SUFENTANIL thoracoscope Radical resection of lung cancer Postoperative cognitive dysfunction
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Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer 被引量:12
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作者 Wenlong Shao Jun Liu +5 位作者 Wehua Liang Hanzhang Chen Shuben Li Weiqiang Yin Xin Zhang Jianxing He 《Chinese Journal of Cancer Research》 SCIE CAS CSCD 2014年第4期418-422,共5页
Objective: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery (VATS) radical treatment for patients with stage ⅢA lung cancer, with the primary endpoint... Objective: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery (VATS) radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods: A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results: A total of 51 patients with non-small cell lung cancer (NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 (80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 (98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage (〉1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients (88.2%) did not suffer from any perioperative complication, and 6 (11.8%) experienced one or more complications. Conclusions: VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer. 展开更多
关键词 lung cancer video-assisted thoracoscopic surgery (VATS) systematic node dissection (SND)
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Comparison of the body pain and trauma degree between uni-portal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer 被引量:1
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作者 Yang Cao Tao Liu Peng-Fei Wang 《Journal of Hainan Medical University》 2017年第8期106-109,共4页
Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-s... Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter. 展开更多
关键词 lung cancer Uniportal video-assisted thoracoscopic SURGERY Three-portal video-assisted thoracoscopic SURGERY PAIN mediator Oxidative stress Inflammation
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Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer 被引量:5
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作者 Wenlong Shao Xinguo Xiong +6 位作者 Hanzhang Chen Jun Liu Weiqiang Yin Shuben Li Xin Xu Xin Zhang Jianxing He 《Chinese Journal of Cancer Research》 SCIE CAS CSCD 2014年第4期391-398,共8页
Background: Video-assisted thoracic surgery (VATS) has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer (NSCLC). However, popularization of this relativ... Background: Video-assisted thoracic surgery (VATS) has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer (NSCLC). However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods: Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results: Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients (69%). The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions: VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC 展开更多
关键词 Non-small cell lung cancer (NSCLC) video-assisted thoracoscopic surgery (VATS) overall survival
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Simultaneous Bilateral Thoracoscopic Pneumonectomy for Early Multiple Primary Lung Cancer Feasibility Analysis
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作者 Zhonglong Zheng Tao Li +2 位作者 Yang Chen Yang Zhang Pan Zhang 《Proceedings of Anticancer Research》 2021年第3期34-38,共5页
Objective:To analyze the feasibility of simultaneous bilateral thoracoscopic lung resection in the treatment of multiple primary lung cancers in the early stage.Methods:The study time range is between March 2019 and M... Objective:To analyze the feasibility of simultaneous bilateral thoracoscopic lung resection in the treatment of multiple primary lung cancers in the early stage.Methods:The study time range is between March 2019 and March 2021.A sample of 30 patients with early multiple primary lung cancer admitted to this hospital were included,and they were divided into a study group,a control group,and samples within the group using a random number table scheme n=15,patients in the control group underwent staged bilateral thoracoscopic pneumonectomy,and patients in the study group underwent bilateral thoracoscopic pneumonectomy at the same time.The indicators of the two groups were compared and analyzed.Results:There was no significant difference in the operation time and intraoperative blood loss between the two groups(P>0.05).There were significant differences in the VAS score,total length of hospital stay,and total surgical costs on the first day after surgery(P<0.05);there was no significant difference in the two groups'postoperative recovery indicators and the incidence of complications(P>0.05).Conclusion:It is safe and feasible to treat patients with multiple primary lung cancer in both lungs at the same time with simultaneous bilateral thoracoscopic surgery,and is suitable for promotion. 展开更多
关键词 The same period Bilateral thoracoscopic lung resection Early multiple primary lung cancer
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Completely video-assisted thoracoscopic lobectomy versus open lobectomy for non-small cell lung cancer greater than 5 cm:a retrospective study 被引量:10
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作者 Bu Liang Li Yun +5 位作者 Yang Fan Zhao Hui Jiang Guan-chao Li Jian-feng Liu Jun Wang Jun 《Chinese Medical Journal》 SCIE CAS CSCD 2012年第3期434-439,共6页
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
关键词 minimally invasive surgery LOBECTOMY completely video-assisted thoracoscopic lobectomy open lobectomy non-small-cell lung cancer
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Clinical experiences with 20 cases of single-direction thoracoscopic lobectomy and systematic lymph node dissection for peripheral NSCLC 被引量:2
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作者 Zhang Zizheng Liu Hanyun 《Journal of Medical Colleges of PLA(China)》 CAS 2012年第4期226-232,共7页
Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were ... Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. Results: Surgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. Conclusion: Single-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures. 展开更多
关键词 video-assisted thoracoscopic surgery Peripheral lung cancer Lymph node dissection
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Lobectomy by video-assisted thoracoscopic surgery(VATS)for early stage of non-small cell lung cancer 被引量:1
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作者 Min ZHU Xiang-Ning FU Xiaoping CHEN 《Frontiers of Medicine》 SCIE CSCD 2011年第1期53-60,共8页
Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperati... Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC. 展开更多
关键词 non-small cell lung cancer video-assisted thoracoscopic surgery LOBECTOMY
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Advances and controversies in the management of early stage nonsmall cell lung cancer 被引量:1
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作者 Angel Cilleruelo-Ramos Esther Cladellas-Gutiérrez +5 位作者 Carolina de la Pinta Laura Quintana-Cortés Paloma Sosa-Fajardo Felipe Couñago Xabier Mielgo-Rubio Juan Carlos Trujillo-Reyes 《World Journal of Clinical Oncology》 CAS 2021年第12期1089-1100,共12页
Complete resection continues to be the gold standard for the treatment of earlystage lung cancer.The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the m... Complete resection continues to be the gold standard for the treatment of earlystage lung cancer.The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer,as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy.There is a growing tendency to perform sublobar resection in selected cases,as,depending on factors such as tumor size,histologic subtype,lymph node involvement,and resection margins,it can produce similar oncological results to lobectomy.Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery. 展开更多
关键词 video-assisted thoracoscopic surgery Sublobar resection Radiofrequency ablation Stereotactic radiosurgery Early stage lung cancer
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单操作孔电视胸腔镜肺癌根治术治疗非小细胞肺癌患者的疗效观察 被引量:1
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作者 严琳 赵倩 +2 位作者 曹彬 章静娴 聂云飞 《实用医院临床杂志》 2024年第1期171-174,共4页
目的观察单操作孔电视胸腔镜(VATS)肺癌根治术对非小细胞肺癌(NSCLC)血管内皮生长因子受体2(VEGFR2)、胸苷激酶1(TK1)水平的影响。方法我院收治的245例NSCLC患者,按手术方式分为对照组(三孔胸腔镜肺癌根治术,n=115)和观察组(单操作孔VAT... 目的观察单操作孔电视胸腔镜(VATS)肺癌根治术对非小细胞肺癌(NSCLC)血管内皮生长因子受体2(VEGFR2)、胸苷激酶1(TK1)水平的影响。方法我院收治的245例NSCLC患者,按手术方式分为对照组(三孔胸腔镜肺癌根治术,n=115)和观察组(单操作孔VATS肺癌根治术,n=130),比较两组围术期指标、视觉模拟(VAS)评分、肺功能、炎性因子、肿瘤标志物、VEGFR2、TK1水平及并发症。结果观察组术中出血量较对照组少(P<0.05);术后,观察组VAS评分、炎性因子、肿瘤标志物和VEGFR2、TK1水平低于对照组,肺功能高于对照组(P<0.05)。结论单操作孔VATS肺癌根治术治疗NSCLC出血量少、疼痛轻,可改善肺功能,降低炎性因子、肿瘤标志物和VEGFR2、TK1水平,且不增加术后并发症,值得临床推广。 展开更多
关键词 非小细胞肺癌 单操作孔 电视胸腔镜 肺癌根治术 血管内皮生长因子受体2 胸苷激酶1
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单孔胸腔镜肺楔形切除术对早期肺癌患者的疗效及对肺功能的影响
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作者 陈方 余龙海 +1 位作者 赵勇 王德昌 《实用癌症杂志》 2024年第10期1688-1691,共4页
目的探讨单孔胸腔镜肺楔形切除术对早期肺癌患者的治疗效果及对肺功能的影响。方法选用120例早期肺癌患者为研究对象,随机分为两组(研究组、对照组各60例)。对照组采用解剖性肺段切除术,研究组采用单孔胸腔镜肺楔形切除术,比较两组治疗... 目的探讨单孔胸腔镜肺楔形切除术对早期肺癌患者的治疗效果及对肺功能的影响。方法选用120例早期肺癌患者为研究对象,随机分为两组(研究组、对照组各60例)。对照组采用解剖性肺段切除术,研究组采用单孔胸腔镜肺楔形切除术,比较两组治疗后手术相关指标、视觉模拟量表(VAS)评分、肺功能指标及并发症发生率。结果研究组术后住院时间、手术时间、术中出血量等手术指标均优于对照组(P<0.05);术后两组VAS评分均上涨(P<0.05),但研究组VAS评分较对照组明显降低(P<0.05);两组肺功能指标均发生显著变化(P<0.05),研究组FEV1、MVV、FVC水平较对照组明显升高(P<0.05);研究组肺感染、肺漏气、肺不张、呼吸衰竭等并发症的总发生率较对照组明显下降(P<0.05)。结论对早期肺癌患者采用单孔胸腔镜肺楔形切除术治疗,效果较为理想,创伤小,恢复快,对肺功能影响不严重,临床应用价值较高。 展开更多
关键词 早期肺癌 胸腔镜下肺楔形切除术 解剖性肺段切除术 单孔 肺功能
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胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果
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作者 张新科 司海超 +4 位作者 司小萌 杨建彬 张爽 秦洪猛 金哲 《癌症进展》 2024年第13期1489-1492,共4页
目的探讨胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果。方法根据麻醉方法的不同将65例胸腔镜肺癌根治术患者分为全麻组(n=31,单纯全身麻醉)和联合组(n=34,胸椎旁神经阻滞联合全身麻醉)。比较两组患者的疼痛情况[视... 目的探讨胸椎旁神经阻滞联合全身麻醉在胸腔镜肺癌根治术患者中的应用效果。方法根据麻醉方法的不同将65例胸腔镜肺癌根治术患者分为全麻组(n=31,单纯全身麻醉)和联合组(n=34,胸椎旁神经阻滞联合全身麻醉)。比较两组患者的疼痛情况[视觉模拟评分法(VAS)评分、术后24 h镇痛泵按压次数]、瑞芬太尼用量、苏醒进程指标、应激反应指标[去甲肾上腺素(NE)、超氧化物歧化酶(SOD)、丙二醛(MDA)]及术后并发症发生情况。结果术后2、6、12、24 h,联合组患者VAS评分均明显低于全麻组(P﹤0.01);联合组患者术后24 h镇痛泵按压次数明显少于全麻组(P﹤0.01)。联合组患者瑞芬太尼用量明显少于全麻组,苏醒时间和自主呼吸恢复时间均明显短于全麻组,差异均有统计学意义(P﹤0.01)。术后,两组患者NE、MDA水平均高于本组术前,SOD水平均低于本组术前,联合组患者NE、MDA水平均低于全麻组,SOD水平高于全麻组,差异均有统计学意义(P﹤0.05)。联合组患者术后并发症总发生率低于全麻组(P﹤0.05)。结论胸椎旁神经阻滞联合全身麻醉应用于胸腔镜肺癌根治术患者,不仅能够减轻疼痛程度和应激反应程度,还能够减少阿片类药物用量,降低并发症发生率。 展开更多
关键词 胸腔镜肺癌根治术 胸椎旁神经阻滞麻醉 全身麻醉 应用效果
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管状胃-食管吻合术联合胸腔镜食管癌切除术治疗食管癌的效果及对胃肠功能的影响
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作者 孙志红 葛鹏 陈鑫 《临床医学研究与实践》 2024年第30期45-48,共4页
目的探讨分析管状胃-食管吻合术联合胸腔镜食管癌切除术治疗食管癌的效果及对胃肠功能的影响。方法选取2021年1月至2023年1月我院收治的70例食管癌患者为研究对象,以随机数字表法将其分为对照组和观察组,各35例。两组均实施胸腔镜食管... 目的探讨分析管状胃-食管吻合术联合胸腔镜食管癌切除术治疗食管癌的效果及对胃肠功能的影响。方法选取2021年1月至2023年1月我院收治的70例食管癌患者为研究对象,以随机数字表法将其分为对照组和观察组,各35例。两组均实施胸腔镜食管癌切除术,对照组联合应用全胃代食管吻合术重建消化道,观察组联合应用管状胃-食管吻合术重建消化道。比较两组的治疗效果。结果观察组的手术时间、腹腔引流时间及住院时间短于对照组,术中出血量少于对照组(P<0.05)。术后,观察组的胸胃静息压、蠕动收缩压及蠕动频率高于对照组(P<0.05)。术后,观察组的肺活量(VC)、用力肺活量(FVC)及第1秒用力呼气容积(FEV_(1))/FVC高于对照组(P<0.05)。术后,观察组的皮质醇(Cor)及β-内啡肽(β-EP)水平低于对照组(P<0.05)。结论管状胃-食管吻合术联合胸腔镜食管癌切除术治疗食管癌能提高手术效果,缩短手术时间和术后恢复时间,减少术中出血量,减轻对胃肠功能、肺功能造成的影响,下调机体应激反应,值得推广。 展开更多
关键词 管状胃-食管吻合术 胸腔镜食管癌切除术 食管癌 胃肠功能 肺功能
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目标导向液体治疗在胸腔镜肺癌根治术中的应用 被引量:1
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作者 梁大顺 王永发 +2 位作者 卓明词 潘焕滨 莫娴 《广东医科大学学报》 2024年第1期89-92,共4页
目的探讨目标导向液体治疗(GDFT)在胸腔镜肺癌根治术中的应用价值。方法94例行胸腔镜肺癌根治术患者随机分为观察组和对照组。观察组采用GDFT,对照组采用常规液体治疗。比较两组患者围术期的血流动力学指标、术中肺通气功能指标、手术... 目的探讨目标导向液体治疗(GDFT)在胸腔镜肺癌根治术中的应用价值。方法94例行胸腔镜肺癌根治术患者随机分为观察组和对照组。观察组采用GDFT,对照组采用常规液体治疗。比较两组患者围术期的血流动力学指标、术中肺通气功能指标、手术观察指标和认知功能。结果在单肺通气1 h和术毕即刻,观察组的平均动脉压(MAP)、中心静脉压(CVP)、呼吸指数(RI)均明显低于对照组,而脑氧饱和度(rSO_(2))和氧合指数(OI)均明显高于对照组(P<0.05或0.01)。观察组胶体补液量、晶体补液量、尿量、补液总量均明显少于对照组,使用血管活性药物构成比低于对照组(P<0.05或0.01)。术后1 d时,观察组的智力状态检查量表(MMSE)评分明显高于对照组,认知功能障碍发生率低于对照组(P<0.05)。结论在胸腔镜肺癌根治术中采用GDFT能够稳定血流动力学,控制容量负荷,减少血管活性药物的使用率,减轻肺通气功能损伤和降低认知功能障碍发生率。 展开更多
关键词 胸腔镜肺癌根治术 目标导向液体治疗
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胸腔镜下两种不同术式对早期NSCLC患者的疗效及对其肺功能和预后等的影响
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作者 孙继红 朱正帅 刘丽 《实用癌症杂志》 2024年第9期1498-1501,共4页
目的探讨胸腔镜下两种不同术式对早期NSCLC患者的疗效及对其肺功能和预后等的影响。方法选取88例早期NSCLC患者(均为ⅠA1期),根据术式差异分为2组。研究组40例,采用胸腔镜下肺楔形切除术治疗,而对照组48例则采用胸腔镜下解剖性肺段切除... 目的探讨胸腔镜下两种不同术式对早期NSCLC患者的疗效及对其肺功能和预后等的影响。方法选取88例早期NSCLC患者(均为ⅠA1期),根据术式差异分为2组。研究组40例,采用胸腔镜下肺楔形切除术治疗,而对照组48例则采用胸腔镜下解剖性肺段切除术治疗,比较2组的临床疗效等差异。结果研究组的手术时间、术中出血量及术后并发症发生率及术后住院时间均优于对照组(P<0.05)。术后2组的肺功能指标均较术前降低,且对照组下降更甚(P<0.05);术后2组的炎性指标均较术前升高,且对照组升高更甚(P<0.05)。术后1年,2组的总生存率及复发率比较,无统计学差异(P>0.05)。结论胸腔镜下肺楔形切除术对早期NSCLC患者的疗效更佳,不仅可缩短手术时间,加快患者术后恢复,同时对肺功能的影响较小,且可降低患者术后的炎性反应程度,最终不影响患者的预后,值得临床推广应用。 展开更多
关键词 非小细胞肺癌 胸腔镜下肺楔形切除术 解剖性肺段切除术 疗效 肺功能 预后
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信迪利单抗联合紫杉醇、顺铂化疗方案治疗后应用胸腔镜肺癌根治术的价值
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作者 邓永 《中国实用医药》 2024年第17期99-103,共5页
目的探讨肺癌患者接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗后采用胸腔镜肺癌根治术的价值。方法104例肺癌患者,以随机数字表法分成研究组(n=52)与对照组(n=52)。两组均接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗,对照组采用开胸... 目的探讨肺癌患者接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗后采用胸腔镜肺癌根治术的价值。方法104例肺癌患者,以随机数字表法分成研究组(n=52)与对照组(n=52)。两组均接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗,对照组采用开胸肺癌根治术治疗,研究组采用胸腔镜肺癌根治术治疗。比较两组围手术期指标(手术时间、留置引流管时间、住院时间、术中出血量、清扫淋巴结数),肺功能指标[肺活量(VC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)],疼痛介质[P物质(SP)、前列腺素E2(PGE2)],应激反应[谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)],炎症因子[白细胞介素(IL)-6、IL-17],生命质量[生命质量测定量表(QLQ-C30)评分],并发症发生情况。结果与对照组的(145.13±1.57)min、(6.18±1.41)d、(16.57±1.68)d、(120.06±1.91)ml、(23.57±1.33)个比较,研究组手术时间(127.83±1.52)min、留置引流管时间(3.41±1.35)d、住院时间(12.57±1.51)d更短,术中出血量(108.92±1.65)ml更少,清扫淋巴结数(27.92±1.55)个更多(P<0.05)。两组术后7 d的VC、FEV1、MVV高于本组术前,研究组术后7 d的VC(2.72±0.58)L、FEV1(2.05±0.75)L、MVV(71.95±5.89)L/min高于对照组的(2.29±0.56)L、(1.76±0.61)L、(65.88±4.52)L/min(P<0.05)。两组术后7 d的SP、PGE2水平高于本组术前,研究组术后7 d的SP(7.78±1.34)μg/ml、PGE2(174.93±4.31)ng/L低于对照组的(9.45±1.56)μg/ml、(192.87±5.24)ng/L(P<0.05)。两组术后7 d的SOD、GSH-Px水平低于本组术前,研究组术后7 d的SOD(149.82±4.37)U/ml、GSH-Px(71.63±3.25)U/ml高于对照组的(112.54±4.12)、(58.71±3.71)U/ml(P<0.05)。两组术后1个月的IL-6、IL-17水平低于本组术前,研究组术后1个月的IL-6(6.52±0.86)pg/ml、IL-17(5.12±1.24)pg/ml低于对照组的(7.13±1.03)、(6.45±1.73)pg/ml(P<0.05)。两组术后1个月QLQ-C30评分高于本组术前,研究组术后1个月QLQ-C30评分(72.64±3.92)分高于对照组的(64.81±3.76)分(P<0.05)。研究组术后并发症发生率为7.69%(4/52),低于对照组的25.00%(13/52)(P<0.05)。结论信迪利单抗联合紫杉醇、顺铂化疗方案治疗后应用胸腔镜肺癌根治术治疗肺癌患者,能够改善围手术期指标,促进其肺功能提高,减少疼痛介质分泌,降低应激反应及炎症因子水平,改善生命质量,减少术后并发症发生。 展开更多
关键词 肺癌 胸腔镜肺癌根治术 围手术期指标 肺功能指标 生命质量 术后并发症
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胸腔镜肺癌切除术后合并心肺并发症的危险因素分析及列线图预测模型构建 被引量:1
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作者 潘永东 朱萍 吕伟 《现代肿瘤医学》 CAS 2024年第4期663-667,共5页
目的:探讨肺癌患者经胸腔镜切除术后合并心肺并发症的危险因素并构建列线图预测模型。方法:选取2019年10月至2022年9月在我院进行胸腔镜切除术的228例肺癌患者为研究对象,将术后出现心肺并发症的52例患者纳入发生组,未出现心肺并发症的... 目的:探讨肺癌患者经胸腔镜切除术后合并心肺并发症的危险因素并构建列线图预测模型。方法:选取2019年10月至2022年9月在我院进行胸腔镜切除术的228例肺癌患者为研究对象,将术后出现心肺并发症的52例患者纳入发生组,未出现心肺并发症的176例患者纳入未发生组。记录两组患者的临床资料,独立样本t检验或χ^(2)检验行单因素分析,探索胸腔镜切除术后合并心肺并发症的相关因素;MedCalc软件对计量指标行ROC曲线分析,探索其对胸腔镜切除术后合并心肺并发症的预测价值;Logistic逐步回归分析探讨胸腔镜切除术后合并心肺并发症的独立危险因素;R语言软件4.0“rms”包构建肺癌患者经胸腔镜切除术后合并心肺并发症的列线图预测模型,校正曲线对列线图预测模型进行内部验证,计算一致性指数(concordance index,C-index),决策曲线对列线图预测模型进行临床预测效能评估。结果:发生组与未发生组患者在年龄、吸烟史、糖尿病史、冠心病史、手术时间、术中出血量、FEV1方面的差异具有统计学意义。年龄、手术时间、术中出血量的AUC分别为0.739、0.785、0.736,最佳截断值分别为55岁、178 min、96 mL。年龄、吸烟史、冠心病史、手术时间、FEV1是肺癌患者经胸腔镜切除术后合并心肺并发症的独立危险因素。内部验证结果指出,列线图预测模型的校正曲线与原始曲线及理想曲线接近,C-index为0.883(95%CI:0.833~0.933),模型拟合度高;列线图预测模型的阈值>0.23,可提供临床净收益,且临床净收益均高于年龄、吸烟史、冠心病史、手术时间、FEV1。结论:本研究基于胸腔镜肺癌切除术后合并心肺并发症的独立危险因素即年龄、吸烟史、冠心病史、手术时间、FEV1构建了列线图预测模型,对心肺并发症的发生具有较好的预测价值,有助于胸腔镜肺癌切除术患者心肺并发症的临床监测,以期降低心肺并发症的发病率,减少不良事件的发生。 展开更多
关键词 肺癌 胸腔镜切除术 心肺并发症 危险因素 列线图预测模型
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老年患者早期非小细胞肺癌胸腔镜下肺叶切除术与肺楔形切除术治疗效果比较
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作者 马志飞 陈文 郑琳 《陕西医学杂志》 CAS 2024年第11期1483-1486,1490,共5页
目的:比较老年患者早期非小细胞肺癌(NSCLC)胸腔镜下肺叶切除术与肺楔形切除术的治疗效果。方法:选取分别行胸腔镜下肺楔形切除术及胸腔镜下肺叶切除术的NSCLC患者为肺楔形切除组和肺叶切除组,各53例。比较两组围手术期指标、肺功能及... 目的:比较老年患者早期非小细胞肺癌(NSCLC)胸腔镜下肺叶切除术与肺楔形切除术的治疗效果。方法:选取分别行胸腔镜下肺楔形切除术及胸腔镜下肺叶切除术的NSCLC患者为肺楔形切除组和肺叶切除组,各53例。比较两组围手术期指标、肺功能及炎症因子水平及并发症发生率。结果:肺楔形切除组术中出血量、术后引流时间及引流量、住院时间低于肺叶切除组(均P<0.05)。与术前比较,两组术后3 d、1个月及3个月第1秒用力呼气量(FEV 1)、每分钟最大通气量(MVV)、用力肺活量(FVC)呈先降低后升高趋势(均P<0.05)。与肺叶切除组比较,肺楔形切除组术后1个月和3个月FEV 1、MVV、FVC升高(均P<0.05)。与术前比较,两组术后1、3 d血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平呈先升高后降低趋势(均P<0.05)。与肺叶切除组比较,肺楔形切除组术后1、3 d血清IL-6、TNF-α水平降低(均P<0.05)。术后6个月,肺楔形切除组并发症总发生率为3.77%,与肺叶切除组11.32%比较差异无统计学意义(P>0.05)。结论:与胸腔镜下肺叶切除术相比,胸腔镜下肺楔形切除术应用于老年患者早期NSCLC能够改善围手术期指标,促进肺功能恢复,降低术后炎症反应,且安全性较好。 展开更多
关键词 非小细胞肺癌 胸腔镜下肺叶切除术 胸腔镜下肺楔形切除术 围手术期 肺功能 炎症因子
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艾司氯胺酮联合竖脊肌平面阻滞对胸腔镜手术患者术后早期恢复质量的影响
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作者 宁晓丽 刘伟 +3 位作者 李娟 邱诚 解凤磊 闫声明 《临床麻醉学杂志》 CAS CSCD 北大核心 2024年第5期473-477,共5页
目的探讨艾司氯胺酮联合竖脊肌平面阻滞(ESPB)对胸腔镜肺部手术患者术后早期恢复质量的影响。方法选择2022年5月至2023年7月行胸腔镜肺部手术(胸腔镜下肺癌根治术、胸腔镜下肺叶或肺段切除术)患者90例,男47例,女43例,年龄18~64岁,BMI 18... 目的探讨艾司氯胺酮联合竖脊肌平面阻滞(ESPB)对胸腔镜肺部手术患者术后早期恢复质量的影响。方法选择2022年5月至2023年7月行胸腔镜肺部手术(胸腔镜下肺癌根治术、胸腔镜下肺叶或肺段切除术)患者90例,男47例,女43例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字法将患者分为两组:ESPB组(C组)和艾司氯胺酮联合ESPB组(D组),每组45例。两组患者完成超声引导下ESPB,随后C组采用舒芬太尼行麻醉诱导和患者自控静脉镇痛(PCIA);D组用艾司氯胺酮行麻醉诱导、麻醉维持和术后PCIA。记录术中麻醉药物用量、术后1、6、12、24、48 h患者活动时NRS疼痛评分、术后24 h内PCIA按压次数、术后补救镇痛次数、麻醉苏醒时间、术后2 d内术后恶心、呕吐及艾司氯胺酮有关不良反应的发生情况。术前1 d、术后2 d采用40项恢复质量量表(QoR-40)评分评估患者恢复质量。术前1 d及出院时采用医院焦虑-抑郁量表(HADS)评估患者焦虑、抑郁情绪。结果与C组比较,D组术中丙泊酚、瑞芬太尼用量明显减少,术后恶心呕吐发生率明显降低,术后2 d QoR-40评分明显升高,出院时HADS评分明显降低(P<0.05)。结论艾司氯胺酮联合ESPB用于胸腔镜肺部手术患者安全有效,围术期镇痛完善,不良反应少,患者早期恢复质量较高,为此类手术提供一种新的麻醉选择。 展开更多
关键词 艾司氯胺酮 竖脊肌平面阻滞 肺癌切除术 术后早期恢复质量 阿片类药物 胸腔镜
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舒更葡糖钠对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响
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作者 李箫 张子洲 王伟 《新疆医科大学学报》 CAS 2024年第2期259-263,共5页
目的探讨舒更葡糖钠注射液对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响。方法选取2020年2月至2022年1月在江苏大学附属镇江三院、常州市第七人民医院于全麻下行胸腔镜肺癌根治术的86例患者为研究对象。应用随机数字表法将患者分... 目的探讨舒更葡糖钠注射液对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响。方法选取2020年2月至2022年1月在江苏大学附属镇江三院、常州市第七人民医院于全麻下行胸腔镜肺癌根治术的86例患者为研究对象。应用随机数字表法将患者分成A、B两组,每组各43例。两组麻醉诱导和术中全麻维持方案相同,使用肌松监测仪(TOF)监测肌松。手术结束后,TOF计数≥2时,A组静脉推注新斯的明(2 mg/kg)、阿托品(0.5 mg/kg)逆转肌松药,B组静脉推注舒更葡糖钠(2 mg/kg)。记录推注肌松拮抗药后5、15、30 min时肌松残余率。观察注射罗库溴铵后5 min(T0)、推注肌松拮抗药后5 min(T1)、15 min(T2)、30 min(T3)时血浆凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平。同时记录气管导管拔除时间及患者发生恶心、呕吐等情况。结果A组给予肌松拮抗药5、15 min后肌松残余率明显高于B组(100.00%vs 13.95%,65.12%vs 0.00%)(χ^(2)=64.939、41.517,P<0.01)。两组患者在相同时间点TT、APTT、PT、FIB指标差异均无统计学意义(P均>0.05)。B组气管导管拔管时间[(3.8±1.1)min]短于A组[(13.9±4.3)min],差异有统计学意义(t=14.922,P<0.001);B组呼吸抑制发生率低于A组(0.00%vs 11.63%)(χ^(2)=5.309,P=0.021)。结论舒更葡糖钠注射液用于胸腔镜肺癌根治术患者,可快速拮抗罗库溴铵的肌松作用,降低肌松残余发生率,缩短气管导管拔管时间,利于患者术后康复。 展开更多
关键词 胸腔镜肺癌根治术 舒更葡糖钠 残余肌松 凝血功能
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