Fagevik Olsén M, Kjellby Wendt G, Hammerlid E, Smedh U
1 Department of Physical Therapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
2 Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Scand J Surg. 2017 Jun;106(2):116-125. doi: 10.1177/1457496916655499. Epub 2016 Jul 1.
There is a risk of decreased physical function, quality of life and persistent pain after open surgery for esophageal cancer. There are currently no studies that evaluate the effect of any postoperative intervention, including physical exercises, after this type of surgery. The aim of the study was therefore to evaluate the effect of a training intervention after Ivor-Lewis resection of the esophagus.
Patients scheduled for esophagus resection according to Ivor-Lewis were randomized to an intervention group or a control group. The training intervention started at discharge and lasted three months. Before discharge, patients were given three leaflets with exercises to increase range of motion in the affected area and exercises aiming to restore lung function and physical function. All exercises were described in detail and the patients carried out the ones in the first program under supervision. Before surgery and three months after discharge, the patients estimated their level of physical function, level of physical activity, and quality of life. They also underwent spirometry, measurements of range of motion in the rib cage, spine, and shoulders, and three functional tests. Comparisons of differences within and between the groups were made.
A total of 43 of 64 randomized patients participated in the follow-up. Postoperatively, the patients in the intervention group had a significantly higher degree of physical function and less deteriorated range of motion in right shoulder flexion and thoracic left lateral flexion. There were no significant differences between the groups in lung function, pain, or quality of life.
The results of the three-month intervention indicate that specific training can positively affect physical function and range of motion to preoperative values. The intervention was well tolerated, and no side effects were registered.
食管癌开放手术后存在身体功能下降、生活质量降低及持续疼痛的风险。目前尚无研究评估此类手术后包括体育锻炼在内的任何术后干预措施的效果。因此，本研究的目的是评估艾弗 - 刘易斯食管切除术后训练干预的效果。
计划接受艾弗 - 刘易斯食管切除术的患者被随机分为干预组和对照组。训练干预在出院时开始，持续三个月。出院前，给患者发放了三份包含增加患侧活动范围练习以及旨在恢复肺功能和身体功能练习的传单。所有练习都有详细描述，患者在监督下进行第一个项目中的练习。手术前及出院后三个月，患者评估了自己的身体功能水平、身体活动水平和生活质量。他们还接受了肺活量测定、胸廓、脊柱和肩部活动范围测量以及三项功能测试。对组内和组间差异进行了比较。
64例随机分组患者中共有43例参与了随访。术后，干预组患者的身体功能程度明显更高，右肩前屈和胸左侧屈的活动范围恶化程度更小。两组在肺功能、疼痛或生活质量方面无显著差异。
为期三个月的干预结果表明，特定训练可对身体功能和活动范围产生积极影响，使其恢复到术前水平。该干预耐受性良好，未记录到副作用。
