Pan Huaguang, Hu Xu, Yu Zaicheng, Zhang Renquan, Zhang Wei, Ge Jianjun
Department of Thoracic Surgery, 1st Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Cardiovascular Surgery, 1st Hospital of Anhui Medical University, Hefei, Anhui, China
Interact Cardiovasc Thorac Surg. 2014 Sep;19(3):441-7. doi: 10.1093/icvts/ivu172. Epub 2014 Jun 10.
The aim of this study was to evaluate the safety and effectiveness of a fast-track surgery (FTS) protocol on patients undergoing minimally invasive oesophagectomy.
We retrospectively analysed the clinical data of 80 eligible patients who underwent elective minimally invasive oesophagectomy in our department from January 2012 to April 2013 by the same surgical team. Two groups of these patients were compared. The control group comprised patients treated with traditional methods. Clinical parameters were compared. The study group was formed by patients treated with the fast-track concept, such as (i) a semi-liquid meal was administered up to 6 h before surgery and the patients were made to drink 200 ml of 10% glucose solution 3 h before surgery; (ii) no nasogastric tube, no abdominal drainage tube and no draining sinus in the neck; (iii) the chest tube and catheter were removed as early as possible; (iv) prevention of hypothermia therapy; (v) an attempt at bedside rehabilitation on postoperative day (POD) 2; and (vi) early postoperative enteral nutrition, restrictive intravenous fluids intraoperatively and postoperatively, and oral feeding initiated 48 h after surgery.
There were no significant differences between the two groups with regard to age, sex, pathologic tumor-node-metastasis stage, tumour location, pathology, American Society of Anesthesiologists score, preoperative albumin level, 30-day readmission or complications (P >0.05). Compared with the conventional group, the FTS group had earlier first flatus [(3 (3-4) vs 6 (6-7) days], less fluid transfusion [2.1 (2.06-2.2) vs 2.8 (2.7-2.9) l] and shorter postoperative hospital stay [7 (6-9) days vs 12 (10-16.5) days] (P <0.05). There was no difference between the two groups with regard to vomiting, but patients in the conventional group suffered from/experienced pharyngitis considerably more than the FTS group (P <0.001).
FTS on patients with oesophageal cancer receiving minimally invasive oesophagectomy is safe, feasible and efficient, and can accelerate postoperative rehabilitation. Compared with the conventional protocol, its advantages were limited to short-term follow-up.
本研究旨在评估快速康复外科（FTS）方案对接受微创食管切除术患者的安全性和有效性。
我们回顾性分析了2012年1月至2013年4月在我科由同一手术团队进行择期微创食管切除术的80例符合条件患者的临床资料。对这些患者进行了两组比较。对照组包括采用传统方法治疗的患者。比较了临床参数。研究组由采用快速康复理念治疗的患者组成，例如：（i）术前6小时内给予半流质饮食，术前3小时让患者饮用200毫升10%葡萄糖溶液；（ii）不放置鼻胃管、不放置腹腔引流管且颈部不设引流窦；（iii）尽早拔除胸管和导管；（iv）预防体温过低治疗；（v）术后第2天尝试床边康复；（vi）术后早期肠内营养，术中及术后限制静脉输液量，并在术后48小时开始经口进食。
两组在年龄、性别、病理肿瘤-淋巴结-转移分期、肿瘤位置、病理、美国麻醉医师协会评分、术前白蛋白水平、30天再入院率或并发症方面无显著差异（P>0.05）。与传统组相比，FTS组首次排气更早[（3（3 - 4）天对6（6 - 7）天]，输液量更少[2.1（2.06 - 2.2）升对2.8（2.7 - 2.9）升]，术后住院时间更短[7（6 - 9）天对12（10 - 16.5）天]（P<0.05）。两组在呕吐方面无差异，但传统组患者咽炎的发生率/经历明显高于FTS组（P<0.001）。
FTS应用于接受微创食管切除术的食管癌患者是安全、可行且有效的，并且可以加速术后康复。与传统方案相比，其优势仅限于短期随访。
