加速康复外科联合单孔胸腔镜在肺癌手术中的应用价值
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摘要
加速康复外科(enhanced recovery after surgery,ERAS)是指在围术期采用一系列具有循证医学证据的优化处理措施,以减轻患者心理和生理的创伤和应激反应,减少术后并发症,缩短住院时间,降低医疗费用,促进患者快速康复。随着胸外科微创技术的不断发展,单孔胸腔镜应运而生,大量临床实践证明在保证肺癌根治性及安全、可行的前提下,单孔胸腔镜肺癌手术在疼痛、创伤等方面具有显著优势。为进一步探讨加速康复外科联合单孔胸腔镜在肺癌手术中的应用价值,现综述如下。
Enhanced recovery after surgery( ERAS) refers to using a series of evidence-based optimal treatment measures during perioperation,in order to alleviate the patients' trauma and stress response,reduce postoperative complications and medical expenses,shorten hospital length of stay and facilitate recovery. With the continuous development of minimally invasive technology in thoracic surgery,uniportal video-assisted thoracoscopic surgery( VATS) emerges. A large number of clinical practices have proved that uniportal VATS has a significant advantage in pain and trauma on the premise of ensuring radical,safe and feasible lung cancer operation. This article reviews the application value of ERAS combined with uniportal VATS for lung cancer.
Enhanced recovery after surgery( ERAS) refers to using a series of evidence-based optimal treatment measures during perioperation,in order to alleviate the patients' trauma and stress response,reduce postoperative complications and medical expenses,shorten hospital length of stay and facilitate recovery. With the continuous development of minimally invasive technology in thoracic surgery,uniportal video-assisted thoracoscopic surgery( VATS) emerges. A large number of clinical practices have proved that uniportal VATS has a significant advantage in pain and trauma on the premise of ensuring radical,safe and feasible lung cancer operation. This article reviews the application value of ERAS combined with uniportal VATS for lung cancer.
引文
[1]Henrik Kehlet.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
[2]Chen WQ,Zheng RS,Baade PD,et al.Cancer statistics in China,2015[J].CA:A Cancer Journal for Clinicians,2016,66(2):115-132.
[3]Chinese Expert Group for Enhanced Recovery Surgery.Chinese expert consensus on enhanced recovery after surgery in perioperative management(2016 edition)[J].Chinese Journal of Surgery,2016,54(6):413-418.[中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016版)[J].中华外科杂志,2016,54(6):413-418.]
[4]Aarts MA,Okrainec A,Glicksman A,et al.Adoption of enhanced recovery after surgery(ERAS)strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay[J].Surg Endosc,2012,26(2):442-450.
[5]Expert Group for Expert Consensus on Airway Management in the Multidisciplinary Perioperative Period.Expert consensus on airway management in the multidisciplinary perioperative period(2016 edition)[J].Chin J Thorac Surg(Electronic Edition),2016,3(3):129-133.[多学科围手术期气道管理专家共识专家组.多学科围手术期气道管理专家共识(2016年版)[J].中华胸部外科电子杂志,2016,3(3):129-133.]
[6]Ding C,Ma HT,Zhao J,et al.The choice of extraction time of thoracic drainage tube in chest rapid rehabilitation surgery[J].Frontiers of Medicine,2013,5(14):238.[丁成,马海涛,赵军,等.胸部快速康复外科胸腔引流管拔除时机的选择[J].医药前沿,2013,5(14):238.]
[7]Cerfolio RJ,Bryant AS.Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output[J].J Thorac Cardiovasc Surg,2008,135(2):269-273.
[8]Gottgens KW,Siebenga J,Belgers EH,et al.Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies[J].Eur J Cardiothorac Surg,2011,39(4):575-578.
[9]Wang Y,Yang YH,Luo L,et al.Choice of pleural drainage tube after single port thoracoscopic for lung cancer[J].Chinese Journal of Cancer Prevention and Treatment,2017,24(18):1310-1314.[王毅,杨彦辉,罗雷,等.单孔胸腔镜肺癌根治术后胸腔引流管的选择[J].中华肿瘤防治杂志,2017,24(18):1310-1314.]
[10]Lu LQ,Cheng YD,Zhang CF.Application of single-port video assisted thoracoscopic without chest tube in fast track thoracic surgery[J].Chin J Thorac Surg(Electronic Edition),2017,4(3):159-163.[卢礼卿,程远大,张春芳.单孔胸腔镜手术无胸管留置在胸外科快速康复中的应用[J].中华胸部外科电子杂志,2017,4(3):159-163.]
[11]Horosz B,Nawrocka K,Malec-Milewska M.Anaesthetic perioperative management according to the ERAS protocol[J].Anaesthesiol Intensive Ther,2016,48(1):49-54.
[12]Xia PH,Zhang JP,Wu YH,et al.Pulmonary perioperative catheter management strategy:A prospective cohort study[J].Chin J Thorac Surg(Electronic Edition),2017,4(3):171-176.[夏平会,张洁苹,吴益和,等.肺部围手术期导尿管管理策略的前瞻性研究[J].中华胸部外科电子杂志,2017,4(3):171-176.]
[13]Gonzalez-Rivas D,Bonome C,Fieira E,et al.Non-intubated video-assisted thoracoscopic lung resections:The future of thoracic surgery[J].Eur J Cardiothorac Surg,2015,49(3):721-731.
[14]Gonzalez-Rivas D.Recent advances in uniportal video-assisted thoracoscopic surgery[J].Chin J Cancer Res,2015,27(1):90-93.
[15]Gonzalez-Rivas D,Yang Y,Guido W,et al.Non-intubated(tubeless)uniportal video-assisted thoracoscopic lobectomy[J].Ann Cardiothorac Surg,2016,5(2):151-153.
[16]Ong CK,Lirk P,Seymour RA.The efficacy of preemptive analgesia for acute postoperative pain management:A meta-analysis[J].Anesth Analg,2005,100(3):757-773.
[17]Rao YF,Wang RR,Lu XY,et al.Progress in the application of non steroidal anti-inflammatory drugs in the perioperative pain management of accelerated rehabilitation surgery[J].Chin J Gen Surg,2017,32(3):282-284.[饶跃峰,王融溶,卢晓阳,等.加速康复外科围手术期疼痛管理中非甾体抗炎药的应用进展[J].中华普通外科杂志,2017,32(3):282-284.]
[18]Zhou SB,Cang J.Intercostal nerve blockade combined with patient-controlled intravenous analgesia for pain relief after video-assisted thoracoscopy[J].Chinese Journal of Clinical Medicine,2011,18(2):226-229.[周时蓓,仓静.肋间神经阻滞联合静脉自控镇痛对胸腔镜手术患者术后镇痛效果的观察[J].中国临床医学,2011,18(2):226-229.]
[19]He HZ.Effects of different formulations of incision infiltration on postoperative pain and blood cell factors in patients undergoing thoracoscopic lobectomy[J].Chinese Journal of Surgery of Integrated Traditional and Western Medicine,2016,22(6):612-614.[何焕钟.不同配方行切口浸润对胸腔镜下肺叶切除患者术后疼痛及血中细胞因子的影响[J].中国中西医结合外科杂志,2016,22(6):612-614.]
[20]Gould MK,Garcia DA,Wren SM,et al.Prevention of VTE in nonorthopedic surgical patients:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e227s-e277s.
[21]Xie D,Wang H,Fei K,et al.Single-port video-assisted thoracic surgery in 1 063 cases:A single-institution experience[J].Eur J Cardiothorac Surg,2016,49(1):31-36.
[22]Hsu PK,Lin WC,Chang YC,et al.Multiinstitutional analysis of single-port video-assisted thoracoscopic anatomical resection for primary lung cancer[J].Ann Thorac Surg,2015,99(5):1739-1744.
[23]Shen Y,Wang H,Feng M,et al.Single-versus multiple-port thoracoscopic lobectomy for lung cancer:A propensity-matched study[J].Eur J Cardiothorac Surg,2016,49(Suppl 1):i48-53.
[24]Shih CS,Liu CC,Liu ZY,et al.Comparing the postoperative outcomes of video-assisted thoracoscopic surgery(VATS)segmentectomy using a multi-port technique versus a single-port technique for primary lung cancer[J].J Thorac Dis,2016,8(Suppl3):287-294.
[25]French DG,Thompson C,Gilbert S.Transition from multiple port to single port video-assisted thoracoscopic anatomic pulmonary resection:Early experience and comparison of perioperative outcomes[J].Ann Cardiothorac Surg,2016,5(2):92-99.
[26]Liu CC,Shih CS,Pennarun NT,et al.Transition from a multiport technique to a single-port technique for lung cancer surgery:Is lymph node dissection inferior using the single-port technique[J]?Eur J Cardiothorac Surg,2016,49(Suppl 1):i64-72.
[27]Lin ZW,Xi JJ,Jiang W,et al.Non-grasping en bloc mediastinal lymph nodes dissection in uniportai video-assisted thoracic surgery for lung cancer[J].Chin J Thorac Cardiovasc Surg,2015,31(11):645-648.[林宗武,奚俊杰,蒋伟,等.无抓持整块纵隔淋巴结清扫在单孔胸腔镜肺癌手术中的应用[J].中华胸心血管外科杂志,2015,31(11):645-648.]
[28]Sun YG,Jiao P,Tong HF,et al.Efficacy and safety of single-port vs two-port video-assisted thoracoscopic lobectomy for lung cancer[J].Chin J Min Inv Surg,2017,17(3):224-227.[孙耀光,焦鹏,佟宏峰,等.单孔与两孔胸腔镜肺叶切除治疗肺癌的对比研究[J].中国微创外科杂志,2017,17(3):224-227.]
[29]Hao ZP,Cai YX,Fu SL,et al.Comparison study of post-operative pain and short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection[J].Chinese Journal of Lung Cancer,2016,19(3):122-128.[郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究[J].中国肺癌杂志,2016,19(3):122-128.]
[30]Luo DB,Gao YF,Wu ZH,et al.Uniportal and the three ports thoracoscope contrast on immune function effects in patients with lung cancer[J].Journal of Clinical and Experimental Medicine,2017,16(8):771-774.[罗洞波,高云飞,吴振华,等.单孔与三孔胸腔镜肺癌根治术对患者免疫功能的影响对比[J].临床和实验医学杂志,2017,16(8):771-774.]
[31]Xia Y,Chang SW,Ye JT,et al.Application effect of fast track surgery for patients with lung cancer:A meta-analysis[J].Chin JLung Cancer,2016,19(12):827-836.[夏燕,常淑文,叶敬霆,等.快速康复外科在肺癌手术患者中应用效果Meta分析[J].中国肺癌杂志,2016,19(12):827-836.]
[32]Li S,Zhou K,Che G.Enhanced recovery programs in lung cancer surgery:Systematic review and meta-analysis of randomized controlled trials[J].Cancer Manag Res,2017,9:657-670.
[33]Harris CG,James RS,Tian DH,et al.Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer[J].Ann Cardiothorac Surg,2016,5(2):76-84.
[34]Gonfiotti A,Viqqiano D,Voltolini L,et al.Enhanced recovery after surgery and video assisted thoracic surgery lobectomy:The Italian VATS Group surgical protocol[J].J Thorac Dis,2018,10(Suppl 4):s564-s570.
[35]Abu Akar F,Chen Z,Yang C,et al.Enhanced recovery pathways in thoracic surgery:The Shanghai experience[J].J Thorac Dis,2018,10(Suppl 4):s578-s582.
[36]Huang H,Ma H,Chen S.Enhanced recovery after surgery using uniportal video-assisted thoracic surgery for lung cancer:A preliminary study[J].Thorac Cancer,2018,9(1):83-87.
[37]Ren ZL,Zhang Y,Ren XP,et al.Application of enhanced recovery after surgery in single port thoracoscopic radical resection of lung cancer[J].Chin J Laparoscopic Surgery(Electronic Edition),2017,10(6):376-380.[任占良,张泳,任小朋,等.加速康复理念在单孔胸腔镜肺癌根治术的应用[J].中华腔镜外科杂志(电子版),2017,10(6):376-380.]
[2]Chen WQ,Zheng RS,Baade PD,et al.Cancer statistics in China,2015[J].CA:A Cancer Journal for Clinicians,2016,66(2):115-132.
[3]Chinese Expert Group for Enhanced Recovery Surgery.Chinese expert consensus on enhanced recovery after surgery in perioperative management(2016 edition)[J].Chinese Journal of Surgery,2016,54(6):413-418.[中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016版)[J].中华外科杂志,2016,54(6):413-418.]
[4]Aarts MA,Okrainec A,Glicksman A,et al.Adoption of enhanced recovery after surgery(ERAS)strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay[J].Surg Endosc,2012,26(2):442-450.
[5]Expert Group for Expert Consensus on Airway Management in the Multidisciplinary Perioperative Period.Expert consensus on airway management in the multidisciplinary perioperative period(2016 edition)[J].Chin J Thorac Surg(Electronic Edition),2016,3(3):129-133.[多学科围手术期气道管理专家共识专家组.多学科围手术期气道管理专家共识(2016年版)[J].中华胸部外科电子杂志,2016,3(3):129-133.]
[6]Ding C,Ma HT,Zhao J,et al.The choice of extraction time of thoracic drainage tube in chest rapid rehabilitation surgery[J].Frontiers of Medicine,2013,5(14):238.[丁成,马海涛,赵军,等.胸部快速康复外科胸腔引流管拔除时机的选择[J].医药前沿,2013,5(14):238.]
[7]Cerfolio RJ,Bryant AS.Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output[J].J Thorac Cardiovasc Surg,2008,135(2):269-273.
[8]Gottgens KW,Siebenga J,Belgers EH,et al.Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies[J].Eur J Cardiothorac Surg,2011,39(4):575-578.
[9]Wang Y,Yang YH,Luo L,et al.Choice of pleural drainage tube after single port thoracoscopic for lung cancer[J].Chinese Journal of Cancer Prevention and Treatment,2017,24(18):1310-1314.[王毅,杨彦辉,罗雷,等.单孔胸腔镜肺癌根治术后胸腔引流管的选择[J].中华肿瘤防治杂志,2017,24(18):1310-1314.]
[10]Lu LQ,Cheng YD,Zhang CF.Application of single-port video assisted thoracoscopic without chest tube in fast track thoracic surgery[J].Chin J Thorac Surg(Electronic Edition),2017,4(3):159-163.[卢礼卿,程远大,张春芳.单孔胸腔镜手术无胸管留置在胸外科快速康复中的应用[J].中华胸部外科电子杂志,2017,4(3):159-163.]
[11]Horosz B,Nawrocka K,Malec-Milewska M.Anaesthetic perioperative management according to the ERAS protocol[J].Anaesthesiol Intensive Ther,2016,48(1):49-54.
[12]Xia PH,Zhang JP,Wu YH,et al.Pulmonary perioperative catheter management strategy:A prospective cohort study[J].Chin J Thorac Surg(Electronic Edition),2017,4(3):171-176.[夏平会,张洁苹,吴益和,等.肺部围手术期导尿管管理策略的前瞻性研究[J].中华胸部外科电子杂志,2017,4(3):171-176.]
[13]Gonzalez-Rivas D,Bonome C,Fieira E,et al.Non-intubated video-assisted thoracoscopic lung resections:The future of thoracic surgery[J].Eur J Cardiothorac Surg,2015,49(3):721-731.
[14]Gonzalez-Rivas D.Recent advances in uniportal video-assisted thoracoscopic surgery[J].Chin J Cancer Res,2015,27(1):90-93.
[15]Gonzalez-Rivas D,Yang Y,Guido W,et al.Non-intubated(tubeless)uniportal video-assisted thoracoscopic lobectomy[J].Ann Cardiothorac Surg,2016,5(2):151-153.
[16]Ong CK,Lirk P,Seymour RA.The efficacy of preemptive analgesia for acute postoperative pain management:A meta-analysis[J].Anesth Analg,2005,100(3):757-773.
[17]Rao YF,Wang RR,Lu XY,et al.Progress in the application of non steroidal anti-inflammatory drugs in the perioperative pain management of accelerated rehabilitation surgery[J].Chin J Gen Surg,2017,32(3):282-284.[饶跃峰,王融溶,卢晓阳,等.加速康复外科围手术期疼痛管理中非甾体抗炎药的应用进展[J].中华普通外科杂志,2017,32(3):282-284.]
[18]Zhou SB,Cang J.Intercostal nerve blockade combined with patient-controlled intravenous analgesia for pain relief after video-assisted thoracoscopy[J].Chinese Journal of Clinical Medicine,2011,18(2):226-229.[周时蓓,仓静.肋间神经阻滞联合静脉自控镇痛对胸腔镜手术患者术后镇痛效果的观察[J].中国临床医学,2011,18(2):226-229.]
[19]He HZ.Effects of different formulations of incision infiltration on postoperative pain and blood cell factors in patients undergoing thoracoscopic lobectomy[J].Chinese Journal of Surgery of Integrated Traditional and Western Medicine,2016,22(6):612-614.[何焕钟.不同配方行切口浸润对胸腔镜下肺叶切除患者术后疼痛及血中细胞因子的影响[J].中国中西医结合外科杂志,2016,22(6):612-614.]
[20]Gould MK,Garcia DA,Wren SM,et al.Prevention of VTE in nonorthopedic surgical patients:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e227s-e277s.
[21]Xie D,Wang H,Fei K,et al.Single-port video-assisted thoracic surgery in 1 063 cases:A single-institution experience[J].Eur J Cardiothorac Surg,2016,49(1):31-36.
[22]Hsu PK,Lin WC,Chang YC,et al.Multiinstitutional analysis of single-port video-assisted thoracoscopic anatomical resection for primary lung cancer[J].Ann Thorac Surg,2015,99(5):1739-1744.
[23]Shen Y,Wang H,Feng M,et al.Single-versus multiple-port thoracoscopic lobectomy for lung cancer:A propensity-matched study[J].Eur J Cardiothorac Surg,2016,49(Suppl 1):i48-53.
[24]Shih CS,Liu CC,Liu ZY,et al.Comparing the postoperative outcomes of video-assisted thoracoscopic surgery(VATS)segmentectomy using a multi-port technique versus a single-port technique for primary lung cancer[J].J Thorac Dis,2016,8(Suppl3):287-294.
[25]French DG,Thompson C,Gilbert S.Transition from multiple port to single port video-assisted thoracoscopic anatomic pulmonary resection:Early experience and comparison of perioperative outcomes[J].Ann Cardiothorac Surg,2016,5(2):92-99.
[26]Liu CC,Shih CS,Pennarun NT,et al.Transition from a multiport technique to a single-port technique for lung cancer surgery:Is lymph node dissection inferior using the single-port technique[J]?Eur J Cardiothorac Surg,2016,49(Suppl 1):i64-72.
[27]Lin ZW,Xi JJ,Jiang W,et al.Non-grasping en bloc mediastinal lymph nodes dissection in uniportai video-assisted thoracic surgery for lung cancer[J].Chin J Thorac Cardiovasc Surg,2015,31(11):645-648.[林宗武,奚俊杰,蒋伟,等.无抓持整块纵隔淋巴结清扫在单孔胸腔镜肺癌手术中的应用[J].中华胸心血管外科杂志,2015,31(11):645-648.]
[28]Sun YG,Jiao P,Tong HF,et al.Efficacy and safety of single-port vs two-port video-assisted thoracoscopic lobectomy for lung cancer[J].Chin J Min Inv Surg,2017,17(3):224-227.[孙耀光,焦鹏,佟宏峰,等.单孔与两孔胸腔镜肺叶切除治疗肺癌的对比研究[J].中国微创外科杂志,2017,17(3):224-227.]
[29]Hao ZP,Cai YX,Fu SL,et al.Comparison study of post-operative pain and short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection[J].Chinese Journal of Lung Cancer,2016,19(3):122-128.[郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究[J].中国肺癌杂志,2016,19(3):122-128.]
[30]Luo DB,Gao YF,Wu ZH,et al.Uniportal and the three ports thoracoscope contrast on immune function effects in patients with lung cancer[J].Journal of Clinical and Experimental Medicine,2017,16(8):771-774.[罗洞波,高云飞,吴振华,等.单孔与三孔胸腔镜肺癌根治术对患者免疫功能的影响对比[J].临床和实验医学杂志,2017,16(8):771-774.]
[31]Xia Y,Chang SW,Ye JT,et al.Application effect of fast track surgery for patients with lung cancer:A meta-analysis[J].Chin JLung Cancer,2016,19(12):827-836.[夏燕,常淑文,叶敬霆,等.快速康复外科在肺癌手术患者中应用效果Meta分析[J].中国肺癌杂志,2016,19(12):827-836.]
[32]Li S,Zhou K,Che G.Enhanced recovery programs in lung cancer surgery:Systematic review and meta-analysis of randomized controlled trials[J].Cancer Manag Res,2017,9:657-670.
[33]Harris CG,James RS,Tian DH,et al.Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer[J].Ann Cardiothorac Surg,2016,5(2):76-84.
[34]Gonfiotti A,Viqqiano D,Voltolini L,et al.Enhanced recovery after surgery and video assisted thoracic surgery lobectomy:The Italian VATS Group surgical protocol[J].J Thorac Dis,2018,10(Suppl 4):s564-s570.
[35]Abu Akar F,Chen Z,Yang C,et al.Enhanced recovery pathways in thoracic surgery:The Shanghai experience[J].J Thorac Dis,2018,10(Suppl 4):s578-s582.
[36]Huang H,Ma H,Chen S.Enhanced recovery after surgery using uniportal video-assisted thoracic surgery for lung cancer:A preliminary study[J].Thorac Cancer,2018,9(1):83-87.
[37]Ren ZL,Zhang Y,Ren XP,et al.Application of enhanced recovery after surgery in single port thoracoscopic radical resection of lung cancer[J].Chin J Laparoscopic Surgery(Electronic Edition),2017,10(6):376-380.[任占良,张泳,任小朋,等.加速康复理念在单孔胸腔镜肺癌根治术的应用[J].中华腔镜外科杂志(电子版),2017,10(6):376-380.]