摘要【目的】分析快速康复外科(Fast track surgery,FTS)在周围型肺癌单孔胸腔镜肺叶切除术患者中的应用价值。【方法】选取本院2018年1月至2019年12月收治的180例周围型肺癌患者,将其随机分为FTS组(观察组)、常规康复组(对照组),各90例,均行单孔胸腔镜肺叶切除术。对照组接受围术期常规康复干预,观察组接受基于FTS理念的围术期干预,两组干预均持续至出院前1 d。对比两组患者手术情况、术后恢复情况、并发症发生情况、康复满意度以及术后疼痛视觉模拟评分(VAS)、动脉血氧饱和度(SaO2)的变化。【结果】观察组患者手术时间、术后下床时间、术后拔管时间、术后住院时间均低于对照组,差异均有统计学意义(P<0.05);观察组术后并发症发生率低于对照组(5.56% vs 15.56%)、术后康复满意度高于对照组(96.67% vs 78.89%),差异有统计学意义(P<0.05)。观察组患者术后4 h、术后24 h、术后48 h 的VAS评分低于对照组;术后2 d患者SaO2高于对照组,差异有统计学意义(P<0.05)。【结论】基于FTS理念开展围术期干预,能够缩短周围型肺癌单孔胸腔镜肺叶切除术患者手术时间、促进术后恢复、提高患者康复满意度、减轻术后疼痛。
Abstract：【Objective】To explore the application value of fast track surgery (FTS) in patients with peripheral lung cancer undergoing single port thoracoscopic lobectomy. 【Methods】A total of 180 patients with peripheral lung cancer in our hospital from January 2018 to December 2019 were randomly divided into the FTS group and the conventional rehabilitation group, with 90 cases in each group. All patients underwent single port thoracoscopic lobectomy. The conventional rehabilitation group received routine rehabilitation intervention during perioperative period, while the FTS group received perioperative intervention based on FTS concept, the intervention lasted until 1 day before discharge. The operation situation, postoperative recovery, complications, rehabilitation satisfaction, VAS and SaO2 were compared between the two groups. 【Results】The operation time of FTS group was significantly shorter than that of conventional rehabilitation group (P<0.05). The time of getting out of bed, postoperative extubation and hospital stay in FTS group were significantly lower than those in conventional rehabilitation group (P<0.05). The incidence of postoperative complications in FTS group was 5.56%, which was lower than 15.56% in conventional rehabilitation group (P<0.05). The postoperative rehabilitation satisfaction of FTS group was 96.67%, which was higher than 78.89% of conventional rehabilitation group (P<0.05). The VAS scores of FTS group at 4 h, 24 h and 48 h after operation were all lower than those of conventional rehabilitation group (P<0.05). The resting SaO2 of FTS group was higher than that of conventional rehabilitation group at 2 days after operation, and the difference was statistically significant (P<0.05). 【Conclusion】The perioperative intervention based on FTS concept can shorten the operation time of single port thoracoscopic lobectomy for peripheral lung cancer, promote postoperative recovery, improve patients' rehabilitation satisfaction and reduce postoperative pain.
杜丽红, 顾雪嫣. 快速康复外科在周围型肺癌单孔胸腔镜肺叶切除术患者中的应用[J]. 医学临床研究, 2021, 38(8): 1124-1127.
DU Li-hong, GU Xue-yan. Application of Fast Track Surgery in Patients with Peripheral Lung Cancer Undergoing Single Port Thoracoscopic Lobectomy. JOURNAL OF CLINICAL RESEARCH, 2021, 38(8): 1124-1127.
[1] VAN HAREN R M, MEHRAN R J, MENA G E, et al. Enhanced recovery decreases pulmonary and cardiac complications after thoracotomy for lung cancer[J].Ann Thoracic Surg,2018, 106(1): 272-279. [2] 靳海荣, 郑佳美, 高赛. 快速康复外科理念在达芬奇机器人肺癌切除术围术期护理中的应用[J].实用临床医药杂志, 2018, 22(12): 75-77. [3] YANG X, LI M, YANG X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis[J].J Thoracic Dis,2018, 10(4): 2186-2195. [4] LERNER A D, FELLER-KOPMAN D. Is bronchoscopic treatment of lung cancer possible?[J].Expert Rev of Respir Med,2019, 13(1): 1-3. [5] 卢桂娥. 快速康复外科理念在自发性气胸患者围术期护理中的应用效果[J].实用心脑肺血管病杂志, 2018, 26(4): 151-153. [6] 向润, 朱江, 李强, 等. 快速康复外科理念下单孔与多孔胸腔镜肺叶切除的病例对照研究[J].中国胸心血管外科临床杂志, 2018, 25(4): 284-288. [7] LI T, LIU Y, ZHANG W, et al. A rapid liquid biopsy of lung cancer by separation and detection of exfoliated tumor cells from bronchoalveolar lavage fluid with a dual-layer “PERFECT” filter system[J].Theranostics,2020, 10(14): 6517-6529. [8] VON MEYENFELDT E M, MARRES G M H, VAN THIEL E, et al. Variation in length of hospital stay after lung cancer surgery in the Netherlands[J].Eur J Cardiothorac Surg,2018, 54(3): 560-564. [9] 韩晓霞, 冯光强, 孙晓丽, 等. 快速康复外科对肺结核病胸腔镜肺叶切除术患者临床康复的效果分析[J].中国地方病防治杂志, 2020, 35(1): 88-89, 91. [10] STOY S P, ROSEN L, MUELLER J, et al. Programmed death‐ligand 1 testing of lung cancer cytology specimens obtained with bronchoscopy[J].Cancer Cytopathol,2018, 126(2): 122-128. [11] SINGH A P, BERMAN A T, MARMARELIS M E, et al. Management of lung cancer during the COVID-19 pandemic practical solutions for resource-constrained settings from adaptions of an international consensus[J].Lung India,2020, 37(5):381-383. [12] Hsia D W, Musani A I. Bronchoscopic therapies for peripheral lung malignancies[J].Clin Chest Med,2018, 39(1): 245-259. [13] NOVOA N M, ESTEBAN P, GÓMEZ HERNÁNDEZ M T, et al. Early exercise pulmonary diffusing capacity of carbon monoxide after anatomical lung resection: a word of caution for fast-track programmes[J].Eur J Cardiothorac Surg,2019, 56(1): 143-149. [14] 冯锐, 冯競, 邹宗望, 等. 快速康复外科在早期非小细胞肺癌微创手术中临床应用[J].中华肿瘤防治杂志, 2020, 27(8): 77-81. [15] 李丽凡, 赵锐瑾, 王宏伟, 等. 快速康复外科理念在肺癌围手术期的干预研究[J].中华医院感染学杂志, 2018, 28(22): 87-90. [16] TANAKA R, OHTSUKA K, OGURA W, et al. Subtyping and EGFR mutation testing from blocks of cytological materials, based on liquid‐based cytology for lung cancer at bronchoscopic examinations[J].Diagn Cytopathol,2020, 48(6): 516-523. [17] 王玉璇, 王海, 杨更朴, 等. 快速康复外科指导下电视胸腔镜手术治疗青少年复发性气胸的临床观察[J].山西医药杂志, 2018, 47(13): 1566-1568. [18] CHEN K, ZHAO H, SHI Y, et al. Perioperative dynamic changes in circulating tumor DNA in patients with lung cancer (DYNAMIC)[J].Clin Cancer Res,2019, 25(23): 7058-7067.
2021, Vol. 38 
