中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

微创食管癌切除术“免管免禁”快速康复学习过程分析

查看全文

目的 探讨微创食管癌切除术“免管免禁”快速康复(ERAS)学习曲线。 方法 分析 2017 年 11 月至 2018 年 8 月在郑州大学附属肿瘤医院接受“免管免禁”处理措施快速康复治疗 38 例食管癌患者的临床资料,其中男 26 例、女 12 例,年龄 42~79 岁。胸上段食管癌 4 例,胸中段食管癌 22 例,胸下段食管癌 12 例。 结果 38 例接受微创食管癌切除术“免管免禁”快速康复处理措施的患者术后平均第 1.66(1~4)d 经口进食,术后平均住院时间 7~22(9.35±3.5)d,术后发生肺炎/肺不张 5 例(13.1%)、心律失常 3 例(7.9%)及呼吸衰竭 1 例(2.6%),总心肺系统并发症 8 例(21%);发生声音嘶哑及可控的进食呛咳 5 例(13.1%),吻合口瘘 1 例(2.6%)、颈部切口积液感染 1 例(2.6%)、纵隔积气感染 1 例(2.6%)及胃排空障碍 2 例(5.2%),总并发症 31.6%。无患者死亡。完成 26 例微创食管癌切除术“免管免禁”处理措施 ERAS 后,手术时间及并发症能够达到相对稳定的状态,进入学习曲线的平台期。 结论 微创食管癌切除术“免管免禁”ERAS 在技术上是安全可行的;其在缩短患者术后住院时间、减轻放置鼻胃管营养管不适上具有优势;微创食管癌切除术“免管免禁”处理 ERAS 的学习曲线大约为 26 例。

Objective To investigate the learning curve of non-tube and early oral feeding procedure following McKeown minimally invasive esophagectomy (MIE). Methods We analyzed the clinical data of 38 patients (26 males, 12 females, aged 42–79 years) with esophageal cancer who received non-tube and early oral feeding procedure after surgery at the Affiliated Tumor Hospital, Zhengzhou University from November 2017 to August 2018. They suffered upper thoracic esophageal cancer (n=4), middle thoracic esophageal cancer (n=22) or lower thoracic esophageal cancer (n=12). Results Thirty-eight patients were performed McKeown MIE successfully. Pneumonia/atelectasis occurred in 5 patients (13.1%), respiratory failure in 1 patient (2.6%), arrhythmia in 3 patients (7.9%), hoarseness in 5 patients (13.1%), anastomotic fistula (2.6%) in 1 patient (2.6%), cervical incision infection in 1 patient (2.6%), pneumomediastinum and infection in 1 patient (2.6%) and gastric emptying disorder in 2 patient (5.2%). Mean hospital stay after operation was 7–22 (9.35±3.5) days. Mean oral feeding time was the postoperative 1.66 days. No death was observed. After 26 patients with McKeown MIE were treated with ERAS procedure, the operation time and complications could reach a relatively stable state and enter a plateau of learning curve. Conclusion Non-tube and early oral feeding ERAS procedure following MIE is technically safe and feasible. It can reduce hospital stay, relieve the discomfort of placement of nasogastric and nutrition tube and may reduce the incidence complications. The learning curve of non-tube and early oral feeding ERAS procedure following MIE is about 26 cases.

关键词: 食管癌; 微创食管癌切除术; 快速康复外科; 免管免禁

Key words: Esophageal cancer; minimally invasive esophagectomy (MIE); enhanced recovery after surgery; non-tube no fasting

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2017, Epub ahead of print.
2. Fransen L, Berkelmans G, Asti E, et al. Fa01.02: The effect of postoperative complications after MIE on Long-Term Survival: a retrospective, multi-center cohort study. Dis Esophagus, 2018, 31(13): 1.
3. Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer, 2013, 21(3): 707-714.
4. Shewale JB, Correa AM, Baker CM, et al. Impact of a fast-track esophagectomy protocol on esophageal cancer patient outcomes and hospital charges. Ann Surg, 2015, 261(6): 1114-1123.
5. Weijs TJ, Berkelmans GH, Nieuwenhuijzen GA, et al. Immediate postoperative oral nutrition following esophagectomy: a multicenter clinical trial. Ann Thorac Surg, 2016, 102(4): 1141-1148.
6. Sun HB, Li Y, Liu XB, et al. Early oral feeding following McKeown minimally invasive esophagectomy: an open-label, randomized, controlled, noninferiority trial. Ann Surg, 2018, 267(3): 435-442.
7. 刘宝兴, 李印, 秦建军, 等. 胸腹腔镜联合与常规三切口食管次全切除术治疗食管癌的比较研究. 中华胃肠外科杂志, 2012, 15(9): 938-942.
8. 中国医师协会胸外科分会快速康复专家委员会. 食管癌加速康复外科技术应用专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(12): 717-722.
9. Sun HB, Li Y, Liu XB, et al. Embedded three-layer esophagogastric anastomosis reduces morbidity and improves short-term outcomes after esophagectomy for cancer. Ann Thorac Surg, 2016, 101(3): 1131-1138.
10. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
11. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
12. Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg, 2012, 256(1): 95-103.
13. van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive mckeown esophagectomy. Ann Surg, 2018, [Epub ahead of print].
14. 赵格非, 张坤鹏, 高树庚, 等. 食管癌McKeown术后颈部吻合口瘘危险因素分析. 中华肿瘤杂志, 2017, 39(4): 287-292.
15. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
16. Markar SR, Arya S, Karthikesalingam A, et al. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(13): 4274-4281.
17. Jones CE, Watson TJ. Anastomotic leakage following esophagectomy. Thorac Surg Clin, 2015, 25(4): 449-459.
18. Sato T, Takayama T, So K, Murayama I. Is retention of a nasogastric tube after esophagectomy a risk factor for postoperative respiratory tract infection? J Infect Chemother, 2007, 13(2): 109-113.
19. 刘晟, 仇明, 江道振, 等. 微创手术学习曲线的新概念与临床意义. 中国微创外科杂志, 2008, 8(1): 5-6.
20. Ninomiya I, Osugi H, Tomizawa N, et al. Learning of thoracoscopic radical esophagectomy: how can the learning curve be made short and flat? Dis Esophagus, 2010, 23(8): 618-626.
21. Okamura A, Watanabe M, Fukudome I, et al. Surgical team proficiency in minimally invasive esophagectomy is related to case volume and improves patient outcomes. Esophagus, 2018, 15(2): 115-121.
22. Tapias LF, Morse CR. Minimally invasive Ivor Lewis esophagectomy: description of a learning curve. J Am Coll Surg, 2014, 218(6): 1130-1140.
23. 李印, 孙海波. 食管癌加速康复外科治疗的进展及展望. 中华胸部外科电子杂志, 2017, 4(3): 140-148.