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腹腔镜-胃镜联合食管癌切除术的全程护理管理

Whole-process nursing management for laparo-gastroscopic esophagectomy.

作者信息

Wang Zhe, Wu Minxuan, Zhao Hui, Cao Lina, Ou Yufeng, Wang Ping, Yang Lingli, Dong Li, Zhang Yiqun, Shen Yaxing

机构信息

Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.

Department of Nursing, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Gastrointest Oncol. 2022 Aug;13(4):1516-1524. doi: 10.21037/jgo-22-669.

Abstract

BACKGROUND

Advances in surgical, anesthesia, and nursing techniques have allowed the development of laparo-gastroscopic esophagectomy (LGE) as a minimally invasive treatment of esophageal cancer. This study summarizes the experience of patient whole-process nursing management for patients who received LGE.

METHODS

The implementation of LGE at Zhongshan Hospital, Fudan University, was initiated in June 2020. The procedure is indicated for patients with thoracic conditions that can compromise the outcomes of traditional surgical procedures, and is performed coordinately by thoracic surgeons and endoscopists. A whole-process nursing protocol covering peri-operative patient management was proposed based on the LGE procedure. The operative outcomes were analyzed in this study.

RESULTS

The data of 10 consecutive patients who received LGE and the whole-process nursing protocol were analyzed, and all patients were compliant with the nursing protocol. Intra-operatively, there were no complications or conversions to other surgical methods. Post-operatively, pulmonary complications occurred in 2 cases [1 patient experienced aspiration, underwent preventive tracheotomy, and was discharged on postoperative day (POD) 10; 1 patient developed a left pleural effusion requiring puncture and drainage, and was discharged on POD 7]. The 30-day mortality was not recorded from the primary LGE cohort.

CONCLUSIONS

The whole-process nursing protocol showed safety and feasibility for patients who underwent LGE. In the future, more specialized and whole-process nursing management will be carried out for patients undergoing such operations.

摘要

背景

外科手术、麻醉和护理技术的进步使得腹腔镜-胃镜联合食管癌切除术(LGE)得以发展,成为食管癌的一种微创治疗方法。本研究总结了接受LGE治疗患者的全程护理管理经验。

方法

复旦大学附属中山医院于2020年6月开始实施LGE。该手术适用于那些胸腔情况可能影响传统手术疗效的患者,由胸外科医生和内镜医生协同进行。基于LGE手术提出了涵盖围手术期患者管理的全程护理方案。本研究分析了手术结果。

结果

分析了连续10例接受LGE及全程护理方案患者的数据,所有患者均遵守护理方案。术中无并发症发生,也未转为其他手术方式。术后,2例发生肺部并发症[1例患者发生误吸,接受预防性气管切开术,术后第10天出院;1例患者出现左侧胸腔积液,需要穿刺引流,术后第7天出院]。主要LGE队列未记录到30天死亡率。

结论

全程护理方案对接受LGE的患者显示出安全性和可行性。未来,将对接受此类手术的患者开展更专业化的全程护理管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82de/9459218/79a193483bfd/jgo-13-04-1516-f1.jpg

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