References

rpmj

Research'n Practical Medicine Journal

Research and Practical Medicine Journal

2410-1893

"QUASAR", LLC

10.17709/2410-1893-2021-8-3-7

rpmj-602

Research Article

Обзоры

Review

Основные компоненты протокола ускоренного выздоровления в хирургии опухолей легкого

Key components of enhanced recovery after surgery protocol in lung cancer surgery

https://orcid.org/0000-0002-9725-5549

Качур

А. К.

Каchur

A. K.

Качур Александр Константинович – врач-онколог отделения торакоабдоминальной онкологии и маммологии клинической больница, SPIN:9251-5890, AuthorID: 1081877, Scopus Author ID: 57193125970

143442, Российская Федерация, г.о. Красногорск, пос. Отрадное, влд. 2, стр. 1

Aleksander K. Kachur – oncologist at the thoracoabdominal oncology and breast care department, SPIN:9251-5890, AuthorID: 1081877, Scopus Author ID: 57193125970

2/1 Otradnoye village, Krasnogorsk district 143442

a.k.kachur@gmail.com

https://orcid.org/0000-0002-7281-3591

Лядов

В. К.

Lyadov

V. K.

Лядов Владимир Константинович – д.м.н., доцент, доцент кафедры онкологии ; заведующий отделением онкологии №4 , SPIN: 5385-7889, AuthorID: 642364, ResearcherID:AAA-3897-2019, Scopus Author ID: 57201392537

105005, г. Москва, ул. Бауманская, д. 17/1; 125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1

Vladimir K. Lyadov – Dr. Sci. (Med.), associate professor, associate professor of the department of oncology ; head of oncology department No. 4, SPIN: 5385-7889, AuthorID: 642364, ResearcherID: AAA-3897-2019, Scopus Author ID: 57201392537

17/1 Baumanskaya str., Moscow 105005; 2/1/1 Barricadnaya str., Moscow 125993

vlyadov@gmail.com

Клиническая больница №1 «Медси»Россия«Medsi» Сlinical Hospital No. 1Russian Federation

ГБУЗ «Городская клиническая онкологическая больница №1 ДЗМ»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияCity Clinical Oncological Hospital No. 1 of the Moscow Department of Health; Russian Medical Academy of Continuing Professional Education of the Ministry of Health of the Russian FederationRussian Federation

2021

23092021

837083

2021

Качур А.К., Лядов В.К.

Каchur A.K., Lyadov V.K.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.rpmj.ru/rpmj/article/view/602

В связи с высокой заболеваемостью раком легкого и необходимостью хирургического лечения данной категории пациентов, внедрение концепции стандартизированного протокола ускоренного выздоровления может позволить добиться снижения количества осложнений после операций и сокращения сроков госпитализации.

Целью данного обзора литературы явилось изучение основных компонентов протокола ускоренного выздоровления в торакальной онкохирургии при проведении видео-торакоскопических вмешательств. Показано, что использование целенаправленных мер в пред- (консультация пациента перед операцией, соблюдение режима приема жидкости и пищи, отказ от рутинного применения седативных препаратов, профилактика венозных тромбозов, использование внутривенных антибиотиков, а также спиртового раствора хлоргексидина для обработки кожи), интра- (профилактика гипотермии, использование торакоскопического доступа, одного дренажа при анатомических резекциях легкого, отказ от плеврального дренажа, установка уретрального катетера только при проведении эпидуральной анестезии не более, чем на 2 часа) и послеоперационном (ранняя мобилизация и прекращение инфузионной терапии, обезболивание с использованием комбинации ацетаминофена и НПВС, поддержание нормоволемии, использование сбалансированных кристаллоидных растворов и нефармакологических мер для коррекции тошноты и рвоты) периодах способствуют улучшению результатов лечения, снижению уровня послеоперационных осложнений и послеоперационной летальности.

Due to the high lung cancer morbidity and the need for surgical intervention in that patient population, introduction of the concept of standard protocol for enhanced recovery after surgery (ERAS) may lead to a significant decrease of the rate of postoperative complications and hospital stay. The aim of the review was to assess the main components of ERAS protocol in thoracic cancer surgery using video-assisted thoracoscopic interventions (VATS). Systematic implementation of specific measures in pre- (patient consulting before the intervention, compliance with fluid and nutrition regimen, exclusion of routine sedation, prophylaxis of venous thrombosis, use of intravenous antibiotics and alcohol skin-prepping solution with chlorohexidine), intra- (prevention of hypothermia, thoracoscopic approach, single-tube approach in anatomic lung resections, exclusion of pleural tube insertion, urethral catheterization for less than 2 hours and only in case of epidural anesthesia) and postoperative (early mobilization and cessation of intravenous infusion, pain control using combination of acetaminophen with NSAIDs, maintenance of normovolemy, use of balanced crystalloid solutions and non-pharmacological measures for nausea and vomiting control) periods promote improved outcomes, decrease of postoperative complication rate and postoperative mortality

опухоли легкогостандартизированный протокол ускоренного выздоровленияторакоскопиярезекция легкогопослеоперационные осложнениялетальность

lung cancerenhanced recovery after surgerythoracoscopylung resectionpostoperative complicationsmortality

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The authors declare that there are no conflicts of interest present.