摘要目的 对比研究快速康复外科(fast track surgery,FTS)和传统手术外科(conservative treatment surgery,CTS)对非小细胞肺癌(nonsmall-cell lung cancer,NSCLC)患者术后肺部并发症的发生率影响.方法 选取2008年01月至2010年05月在本科对40例非小细胞肺癌行肺叶切除术患者采用FTS治疗(FTS组);和同期40例按CTS围手术期处理的同种患者(CTS组)作对照.比较两组患者术后肺部并发症(肺部感染、肺不张、持续漏气＞7 d)的发生率;同时分析两组术后辅助通气时间、手术结束时体温、ICU停留时间以及住院时间等情况.结果 FTS组较CTS组术后肺部并发症的发生率显著减少(34.21%vs 8.33%,P＜0.05);两组ICU停留时间的中位数相差1天;FTS组住院天数较CTS组明显减少[(11.1±3.6)d vs(16.6±5.7)d,P＜0.01].结论 按照FTS原则对NSCLC患者进行手术治疗,选择合适的围手术期处理以减少术后肺部并发症的发生率,促进患者早期康复.

abstractsObjective In a prospective randomized controlled pilot study, effects of postoperative pulmonary complications on a conservative treatment surgery (CTS) and fast track surgery (FTS) treatment regimen in non-small cell lung cancer (NSCLC) patients undergoing pulmonary lobectomy were compared.Methods Eighty patients who underwent radical pulmonary lobectomy surgical treatment for non-small cell lung cancer disease from January 2008 to May 2010 in our hospital were random assigned to either fast track surgery treatment (40 FTS group) or conservative treatment surgery regimen (40 CTS group). Study endpoints were pulmonary complications ( pneumonia, atelectasis, prolonged air leak ＞ 7 days); Further parameters assessed in the postoperative course of patients were the need for postoperative mechanical ventilation, temperature at the end of the operation, length of stay (LOS) on intensive care unit (ICU) and day of discharge. Results The rate of postoperative pulmonary complications was 34. 21% in CTS group and 8. 33% in FTS group ( P ＜0. 05). Median length of stay on ICU was comparable in both groups ( 1 day),but the day of discharge was significantly different in both groups [( 11. 1 ±3.6)d vs ( 16. 6 ±5.7)d, P ＜0. 01]. Conclusion Using this fast track clinical pathway, the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen. Our results supported the implementation of an optimized perioperative treatment in lung surgery for non-small cell lung cancer patients undergoing radical pulmonary in order to reduce pulmonary complications after major lung surgery.