The Application Of Enhanced Recovery After Surgery Combined With Thoracoscopy In Lung Cancer Surgery

Part Ⅰ BackgroundAt present,thoracoscopic surgery has become the main surgical method for early lung cancer.But the incidence of postoperative complications is still high,and the reason is unknown.ObjectiveA retrospective study was conducted to explore the high-risk factors of postoperative complications in patients undergoing thoracoscopic surgery for early lung cancer.Materials and MethodsThe patients who underwent thoracoscopic lung cancer resection in our hospital from 2016 to 2018 were selected and divided into two groups according to the occurrence of complications.We investigated the high-risk factors of postoperative complications based on univariate anylysis and multivariate anylysis.ResultsAfter exclusion,a total of 212 cases were included.A total of 114 cases developed complications,and 98 cases had no complications.1.Between two groups,there are significant differences in age,basic disease before surgery,time of getting out of bed,urinary indwelling time,chest tube indwelling time and anesthesia time(P <0.05).2.The results of multi-factor analysis showed that the time of getting out of bed and the anesthesia time were statistically significant(P <0.05,OR> 1).Part Ⅱ BackgroundEnhanced Recovery After Surgery(ERAS)has developed rapidly in thoracic surgery,but the effect of ERAS combined with thoracoscopic lung cancer surgery is still inconclusive.The traditional perioperative indicators cannot successfully evaluate ERAS.Studies showed that symptoms,as a new method for evaluating the application effect of ERAS,deserve attention.ObjectiveThe effect of ERAS combined with thoracoscopy technology in patients with early lung cancer surgery was evaluated by the relevant indicators of the perioperative period and the recovery of postoperative symptoms.And the application value of the MD Anderson symptom Inventory(MDASI)in postoperative symptoms of lung cancer was evaluated.Materials and MethodsWe randomly selected patients who underwent thoracoscopic lung cancer resection in our hospital between 2019.01 and 2019.09.According ERAS treatment condition,they were divided into two groups.The experimental group received thoracoscopy surgery with ERAS treatment,and the control group received thoracoscopic surgery alone.After discharge,the patients were followed up with the MDASI,and the end point of follow-up was defined as all symptoms disappearance.The changes of perioperative related indexes and postoperative symptom recovery indexes of the two groups were analyzed.ResultsAfter exclusion,80 patients were included,including 40 in the experimental group and 40 in the control group.1.There was no significant difference between the two groups in smoking,basic disease before surgery,tumor location,tumor stage,tumor type and age(P>0.05).2.Compared with the control group,the urinary catheter removal time [x±s,46.20 ± 23.381 vs 70.60 ± 29.251(h)](P <0.05),chest tube removal time [x±s,3.35 ± 1.145 vs 4.97 ± 2.665(d)](P <0.05)and the length of hospital staying [x±s,8.05 ± 3.486 vs 10.63 ± 3.933(d)] in the experimental group were significantly shorter(P <0.05).3.There was no significant difference in the overall complication rate between the two groups(P> 0.05),but the incidence of lung infection in the experimental group was significantly lower than that in the control group(2.5% vs 20.0%,P<0.05),and the incidence of severe abdominal distension in the experimental group was lower(5.0% vs 25.0%,P <0.05).4.The results of postoperative follow-up showed that the total follow-up time in the experimental group was shorter than that in the control group [x±s,4.08 ±0.664 vs 4.80 ± 0.791(month)](P <0.05).Compared with the control group,the decreasing trend of the total symptom score in the experimental group was more obvious,and the total symptom score in the experimental group droped to 0 points faster(P <0.05).5.The Kronbach coefficient after the correction of the MDASI was > 0.7,Retest reliability coefficient was > 0.80.Conclusions1.The time of anesthesia and the time of getting out of bed are possitively correlated to the occurrence of complications after thoracoscopic lung cancer resection.2.ERAS treatment combined with thoracoscopic lung cancer surgery can speed up the removal of chest tube and urinary tube,reduce the incidence of pulmonary infections,abdominal distension,reduce the length of hospital staying,and also accelerate the recovery of postoperative symptoms.Therefore,ERAS treatment combined with thoracoscopic surgery for lung cancer is effective and can accelerate the postoperative recovery of lung cancer patients.3.The MDASI has good reliability and validity,and can be used to evaluate the recovery of postoperative symptoms in patients with lung cancer.