胸腔镜联合加速康复外科流程在肺癌手术中应用的临床研究  

Thoracoscopes and fast track surgery in lung cancer lobectomy

作　　者：乔坤[1] 曾绮桥[1] 林少霖[1] 王正[1] 洪英才[1] 任康奇[1] 

机构地区：[1]暨南大学第二临床学院胸外科,深圳518020

出　　处：《中华腔镜外科杂志（电子版）》2013年第1期27-31,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：深圳市科创委(201202135)

摘　　要：目的评价胸腔镜联合加速康复外科(FTS)流程在肺癌手术中应用的可行性。方法 2006年1月至2010年12月对249例行肺癌根治手术的患者,分别应用后外侧小切口开胸肺切除(Ⅰ组)、单纯胸腔镜辅助开胸(Ⅱ组)、FTS联合胸腔镜辅助开胸(Ⅲ组)3种治疗模式,快速康复流程包括:有效宣教、有效镇痛、早期下床、早期拔管,对比3组患者临床指标。结果 3组均无手术死亡病例,Ⅱ、Ⅲ组与Ⅰ组相比,术中出血量明显降低、切口长度减少、术后曲马多针用量减少,但手术时间延长,以上各项差异均有统计学意义(P<0.05);Ⅲ组与Ⅰ、Ⅱ组相比,术后下床时间、术后住院天数、胸管拔除时间明显缩短,术后曲马多针用量明显减少,术后并发症发生率明显降低,差异具有统计学意义(P<0.05)。结论胸腔镜联合加速康复外科可缩短术后住院时间,加快肺癌患者术后康复。Objective To study the feasibility of video-assisted thoracoscopic surgery and fast track surgery ( FTS ) in lung cancer lobectomy. Methods Two hundred and forty-nine lung cancer pantients undergoing lobectomy were recruited prospectively. Pantients were assigned to receive mini-thoracotomy ( Ⅰ , n = 78 ) , video-assisted thoracoscopic surgery ( Ⅱ , n = 82 ) or video-assisted thoracoscopic surgery and FTS management ( Ⅲ , n = 89 ). The FTS care included effective admission missionary,effective analgesia,early ambulation,early extubation. The length of postoperative hospital stay, postoperative complications, time to first ambulation, operation time, intraoperative blood in the three groups were recorded and compared. Results The three groups had no operative deaths, Ⅱ , Ⅲ group compared with the group Ⅰ significant reduced blood loss, reduced incision length, postoperative tramadol reduce the amount of multi-pin, but the surgery time, the above difference was statistically significant ( P < 0.05 ), Ⅲ group compared with group Ⅰ and Ⅱ ,first ambulation, postoperative hospital stay, chest tube disconnect was significant shorter, postoperative tramadol significant reduced the amount of postoperative complications was significant reduced, and the all these difference was statistically significant ( P < 0.05 ). Conclusions Video-assisted thoracoscopic surgery and FTS are safe and efficient,and they can shorten postoperative hospital stay and improving recovery.

关 键 词：肺癌 肺叶切除术 加速康复外科 胸腔镜 

分 类 号：R734.2[医药卫生—肿瘤]