Imai Takeharu, Abe Tetsuya, Uemura Norihisa, Yoshida Kazuhiro, Shimizu Yasuhiro
The Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
The Department of Surgical Oncology, Gifu University, Graduate School of Medicine, Gifu, 501-1194, Japan.
Esophagus. 2018 Jul;15(3):165-172. doi: 10.1007/s10388-018-0608-x. Epub 2018 Mar 12.
We retrospectively compared the effects of immediate extubation (IE) in the operating room with those of overnight mechanical ventilation (MV) after radical transthoracic esophagectomy with 3-field lymphadenectomy in patients with thoracic esophageal cancer.
A total of 96 patients were evaluated. 48 patients were extubated in the operating room after surgery (IE group). The other 48 patients were extubated on the following morning (MV group). The propensity score-matching method was used to assemble a well-balanced cohort. Clinical and postoperative outcomes were investigated in each group. We also compared postoperative laboratory parameters between groups.
The rate of ambulation on postoperative day (POD) 1 was significantly higher in the IE group compared with that in the MV group (50 vs 19%, respectively, p = 0.003). Moreover, the rate of catecholamine use in the ICU was significantly lower in the IE group compared with that in the MV group (15 vs 65%, respectively, p < 0.001). With regard to postoperative respiratory management, there were no significant differences between groups. The length of ICU stay after esophagectomy was significantly shorter in the IE group compared with that in the MV group (p = 0.01), whereas the length of postoperative hospital stay was similar between groups (p = 0.265). There were also no significant differences in the incidence of postoperative complications.
IE in the operating room is not only safe and feasible, even after transthoracic esophagectomy with radical 3-field lymphadenectomy, but also contributes to decrease in catecholamine use, to increase in ambulation on POD 1 and to shorten the ICU stay.
我们回顾性比较了胸段食管癌患者行根治性经胸食管切除术加三野淋巴结清扫术后在手术室即刻拔管（IE）与过夜机械通气（MV）的效果。
共评估了96例患者。48例患者术后在手术室拔管（IE组）。另外48例患者于次日早晨拔管（MV组）。采用倾向评分匹配法组建一个均衡的队列。对每组的临床和术后结果进行研究。我们还比较了两组术后的实验室参数。
IE组术后第1天的下床活动率显著高于MV组（分别为50%和19%，p = 0.003）。此外，IE组在ICU使用儿茶酚胺的比例显著低于MV组（分别为15%和65%，p < 0.001）。关于术后呼吸管理，两组之间无显著差异。IE组食管切除术后在ICU的住院时间显著短于MV组（p = 0.01），而两组术后住院时间相似（p = 0.265）。术后并发症的发生率也无显著差异。
即使在进行根治性三野淋巴结清扫的经胸食管切除术后，在手术室即刻拔管不仅安全可行，而且有助于减少儿茶酚胺的使用，增加术后第1天的下床活动，并缩短在ICU的住院时间。
