Objective To investigate the impact of complete video-assisted thoracoscopic lobectomy and open lobectomy on perioperative heart rate （HR） and blood oxygen saturation （SO2） of lung cancer patients，and explore whether minimally invasive surgery can enhance postoperative recovery of lung cancer patients. Methods A total of 138 lung cancer patients were chosen from 161 consecutive patients with pulmonary diseases who were admitted to West China Hospital of Sichuan University between September 2010 and December 2011. According to different surgical approach，all the 138 lung cancer patients were divided into routine thoracotomy group （thoracotomy group，70 patients including 53 males and 17 females with their average age of 56.1±9.7 years） and complete video-assisted thoracoscopic lobectomy group （VATS group，68 patients including 46 males and 22 females with their average age of 53.4±6.5 years）. There was no statistical difference in preoperative clinical characteristics between the 2 groups. Preoperative and postoperative （1st，3rd，7th and 30th day） numeric pain rating scale （NPRS），HR and SO2 were compared between the 2 groups. Results （1） There was no statistical difference in NPRS on the 1st and 3rd postoperative day between the 2 groups （3.83±0.79 vs. 3.93±0.67， 2.88±0.59 vs. 3.03±0.71，P＞0.05），but on the 7th and 30th postoperative day，NPRS of the thoracotomy group was signi- ficantly higher than that of VAST group （1.61±0.33 vs. 1.22±0.12，1.58±0.26 vs. 1.19±0.31，P＜0.05）. （2） Postop- erative sedentary HR of both VATS group and thoracotomy group were significantly higher than preoperative levels ［（84.13±17.21） / minute vs. （73.67±10.32）/minute， （86.13 ±19.67） / minute vs. （72.24±14.21） / minute， P＜0.05］. Postoperative HR of VATS group decreased to preoperative level on the 3rd postoperative day，while postoperative HR of the thoracotomy group decreased to preoperative level on the 7th postoperative day. （3） There was no statistical difference between preoperative and postoperative （all the time points） sedentary SO2 of both VATS group and thoracotomy group （96.34 %±2.11% vs. 97.12%±2.31%，95.33%±4.13% vs. 94.93% ±4.31%，P＞0.05）.（4） The changes of HR and SO2 before and after exercise of VATS group were significantly smaller than those of the thoracotomy group on the 3rd postoperative day ［（11.11±4.81）/minute vs. （18.23±6.17）/minute，3.1%±1.2% vs. 7.4 %±2.7%，P＜0.05］ . Conclusion The impact of complete video-assisted thoracoscopic lobectomy on cardiopulmonary function is comparatively smaller，which is helpful for postoperative fast-track recovery of lung cancer patients.
Abstract: Objective To investigate the safety and feasibility of fast track (FT) treatment in young children with atrioventricular septal defect (CAVSD) and pulmonary artery hypertension (PAH) following surgical repair. Methods A total of 51 young children patients including 24 boys and 27 girls with age at 12.5±8.9 months from 4 to 36 months, underwent CAVSD repair in the pediatric surgery department of Fu Wai Hospital from January 2006 to March 2009. Among them, 21 patients were administered FT management. PICU length of stay and the rate of reintubation were analyzed retrospectively and the decrease of pulmonary artery pressure (PAP) after operation was also measured. Results Twentyone patients under FT treatment were extubated within 8 hours after operation. The mean pulmonary artery pressure(MPAP) decreased significantly after surgery (39.59 mm Hg vs.24.50 mm Hg,t=5514,Plt;0.05). PICU length of stay was 2.05±0.87 d (18 h-3 d). One patient was reintubated due to lung infection, which had nothing to do with the FT treatment. During the followup which lasted for 3 to 6 months, 21 patients had good heart function with no reoperation or death. Conclusion FT treatment is safe and feasible to some CAVSD patients associated with PAH, and shorter PICU length of stay can be achieved. The validation of FT model for the CAVSD patients with severe PAH needs research with large sample.
Objective To evaluate the use of fast track surgery （FTS） in the treatment for cholecystolithiasis combined with calculus of common bile duct （CBD） by combination of laparoscope and duodenoscope. Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecyst-ectomy （LC） and endoscopic retrograde cholangiopancreatography （ERCP） were divided into FTS group （n=55） and conventional group （n=65），which were accepted the perioperative therapy of FTS or conventional therapy，respectively. After operation，the incision pain，nausea and vomiting，infusion time，loss of body weight，out-of-bed time，dieting time，postoperative hospitalization，hospital costs，and complications were compared in two groups. Results Compared with the conventional group，the postoperative infusion time，dieting time，out-of-bed time，and postoperative hospitali-zation were shorter，the incidence rates of pulmonary infection，and urinary systems infection，pancreatitis，nausea and vomiting， and incision pain were lower，the loss of body weight was lower in the FTS group （P＜0.05），but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P＞0.05）. Conclusion The FTS is safe，economic，and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.
Objective To explore the variation about the application of fast-track surgery and laparoscopy in treatment for colorectal cancer in recent years． To investigate the probability of combining protocols of the two for treatment for colorectal cancer. Methods The clinical and basic literatures of related researches about colorectal treatment of laparoscopy and fast-track surgery were collected and reviewed. Results Compared with the traditional treatment modalities, both of fast-track surgery and laparoscopy used for the treatment of colorectal cancer have better clinical effects. Conclusions Fast-track surgery and laparoscopic techniques used for the treatment of colorectal cancer are feasible, but the combination of the two should be confirmed by further randomized controlled trials.
Objective To explore the concept, contents and existing problems of the fast-track programmes in colorectal surgery. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of the colorectal cancer and fundament investigation in recent years were collected and reviewed. Results The fast-track programmes enhance recovery of the patients who underwent the colorectal resection with the combination of multimodal techniques and approaches. Conclusion The fast-track programmes in colorectal surgery is the typical modality of the multi-disciplinary treatment, this modality can decrease the complications and reduce the hospital stay with preserve the well physiological fundament of the patients.
ObjectiveTo investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. MethodsA total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group (n=89) and FTS group (n=82). Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein (CRP) and interleukin-6 (IL-6) levels in serum were observed postoperatively. ResultsFor the FTS and control group, the first exhaust time was respectively (2.4±0.3) and (3.3±0.6) days, postoperative hospital stay was (9.1±2.7) and (14.1±4.1) days, hospitalization expense was (16 432±3 012) and (21 612±1 724) yuan, all of which had significant differences (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively (8.57±2.58), (30.21±12.44), (17.41±11.73), (11.14±7.12), and (10.50±5.19) ng/L, and for the control group was respectively (9.13±2.99), (51.31±19.50), (36.82±12.33), (28.23±9.18), and (15.44±4.33) ng/L. There was no significant difference in the preoperative IL-6 level between the two groups (P>0.05), while IL-6 level was significantly lower in the FTS group than the control group after surgery (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively (18.41±4.01), (69.74±26.03), (45.52±20.50), (39.14±11.23), and (29.03±6.47) μg/L, and for the control group was respectively (17.74±2.11), (99.23±23.50), (86.81±17.34), (68.22±15.60), and (37.70±9.55) μg/L. There was no significant difference in the preoperative CRP level between the two groups (P>0.05), while CRP level was significantly lower in the FTS group than the control group after surgery (P<0.05). Postoperative complication rate after surgery was not significantly different between the two groups (P>0.05). ConclusionThe application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.