摘要
目的 总结分析解剖性部分肺叶切除术(APL)以及围术期加速康复外科(ERAS)的统筹应用经验,以期为肺癌外科微创治疗的综合管理提供临床参考与理论支持。方法 回顾性分析中国医学科学院肿瘤医院胸外科肺癌数据库2013年11月1日至2021年10月31日接受APL手术的6 449例患者的临床病理学资料以及围手术期数据,包括性别、年龄、吸烟史、手术方式、病理、术后住院日等指标。以2014—2018年作为经验积累阶段,2019—2021年作为技术成熟阶段。比较两阶段在手术量、良性结节占比、术后平均住院日、术后住院日超7 d的差异。结果 纳入患者6 449例,其中男2 094例,女4 355例。分期完成两侧肺部手术88台,同期完成双侧手术8台,共完成APL手术6 493台。技术成熟阶段较经验积累阶段的年度月均手术量增加、良性结节占比减少、术后平均住院日缩短、术后住院日超7 d占比减少(P<0.05)。通过结合ERAS理念优化本中心APL围术期管理细节,成功使得患者术后平均住院日从6.98 d显著降至3.96 d。术后住院日超7 d患者占比由23.80%降至2.87%,多因素Logistic回归分析结果显示性别、年龄、手术术式、手术阶段是APL术后住院日超7 d的独立危险因素。结论 ERAS能够优化APL围术期管理流程,加速患者术后康复。而APL手术可以在保证肿瘤学原则的前提下,为患者保留更多的健康肺组织,实现手术切除范围、手术创伤的最小化,为ERAS理念能够更好地在肺癌根治手术中应用推广提供了必要的临床实践基础。
Objective To summarize the application of anatomical partial lobectomy(APL) and enhanced recovery after surgery(ERAS) in order to provide clinical reference and theoretical support for the comprehensive management of minimally invasive surgical treatment of lung cancer. Methods The clinicopathological and perioperative data of 6,449 patients who underwent APL during Nov. 1, 2013 and Oct. 31, 2021 were retrospectively collected, including gender, age, smoking history, surgical method, pathology, postoperative hospital stay and other indicators. The period from 2014 to 2018 was regarded as the experience accumulation stage, and the period from 2019 to 2021 the technology maturity stage. The number of surgery, percentage of benign nodules, average postoperative hospital stay, and percentage of postoperative hospital stay over 7 days were compared between the two stages. Results Of the 6,449 patients, 2,094 were males and 4,355 were females. Among them, 88 bilateral lung surgeries were performed in stages, and 8 bilateral surgeries were performed simultaneously, and altogether 6,493 APL surgeries were performed. Compared with the experience accumulation stage, in the technology maturity stage, the annual average monthly number of operations increased, the percentage of benign nodules decreased, the average postoperative hospital stay shortened, and the percentage of postoperative hospital stay longer than 7 days decreased(P<0.05). With the application of ERAS from 2014 to 2021, the average annual postoperative hospital stay for APL gradually decreased from 6.98 days to 3.96 days. The percentage of patients with postoperative hospital stay exceeding 7 days decreased from 23.80% to 2.87%. The results of multivariate Logistic regression analysis showed that gender, age, surgical procedure, and surgical stage were independent risk factors for postoperative hospital stay more than 7 days after APL. Conclusion ERAS can optimize the perioperative management of APL and accelerate postoperative recovery of patients. APL can be performed on the premise of oncology principles, preserve more healthy lung tissue, minimize the scope of surgical resection and surgical trauma, so that the concept of ERAS can be better applied and promoted in radical surgery for lung cancer.
作者
彭岳
刘雷
李原
别凤龙
周博伦
李润泽
冀瑛
白广宇
谭锋维
高禹舜
牟巨伟
薛奇
邱斌
高树庚
PENG Yue;LIU Lei;LI Yuan;BIE Fenglong;ZHOU Bolun;LI Runze;JI Ying;BAI Guangyu;TAN Fengwei;GAO Yushun;MU Juwei;XUE Qi;QIU Bin;GAO Shugeng(Department of Thoracic Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Thoracic Surgery,Beijing Institute of Respiratory Medicine and Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Chengde Central Hospital,The Second Clinical College of Chengde Medical University,Chengde 067000,Hebei,China)
出处
《山东大学学报（医学版）》
CAS
北大核心
2022年第11期44-53,共10页
Journal of Shandong University:Health Sciences
基金
国家重点研发计划(2021YFC2500900)
国家自然科学基金(82273129)
中国医学科学院医学与健康科技创新工程(2021-I2M-1-015)
中央保健专项资金(2022ZD17)
院所科研课题(LC2019L01)
关键词
加速康复
解剖性部分肺叶切除术
胸腔镜
肺癌
肺结节
Enhanced recovery after surgery
Anatomical partial lobectomy
Thoracoscopy
Lung cancer
Pulmonary nodules
作者简介
通信作者:高树庚。E-mail:gaoshugeng@cicams.ac.cn;通信作者:邱斌。E-mail:drqiubin@aliyun.com;共同第一作者:彭岳;共同第一作者:刘雷
