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Основные компоненты протокола ускоренного выздоровления в хирургии опухолей легкого

https://doi.org/10.17709/2410-1893-2021-8-3-7

Аннотация

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.

Об авторах

А. К. Качур
Клиническая больница №1 «Медси»
Россия

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


Конфликт интересов:

Авторы заявляют об отсутствии конфликта интересов



В. К. Лядов
ГБУЗ «Городская клиническая онкологическая больница №1 ДЗМ»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России
Россия

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


Конфликт интересов:

Авторы заявляют об отсутствии конфликта интересов



Список литературы

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394–424. https://doi.org/10.3322/caac.21492

2. Чиссов В.И., Трахтенберг А.Х., Пикин О.В., Паршин В.Д. Метастатические опухоли легких. М.: ГЕОТАР-Медиа, 2009, 236 с.

3. Герасимов С.С., Иванов С.М., Маренич А.Ф. Клинические рекомендации по диагностике и лечению больных раком легкого. Общероссийский Союз Общественных Объединений Ассоциация Онкологов России. М.: 2014. Доступно по: https://oncology-association.ru/wp-content/uploads/2020/09/rak-trahei-1.pdf

4. Ginsberg MS, Griff SK, Go BD, Yoo HH, Schwartz LH, Panicek DM. Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients. Radiology. 1999 Oct;213(1):277–282. https://doi.org/10.1148/radiology.213.1.r99oc08277

5. Bozzone A, Romanelli A, Magrone G, Pascoli M, Milazzo M, Sterzi S. Pulmonary rehabilitation: pre-and postoperative treatment. Rays. 2004 Dec;29(4):431–433.

6. Guinard S, Falcoz P-E, Olland A, Renaud S, Reeb J, Santelmo N. Évolution de la prise en charge chirurgicale des cancers pulmonaires en France: lobectomie mini-invasive versus lobectomie par thoracotomie d’après la base de données nationale Epithor. Chirurgie Thoracique et Cardio-vasculaire. 2015 Jan 1;19:27–31.

7. Killoran A, Crombie H, White P, Jones D, Morgan A. NICE public health guidance update. J Public Health (Oxf). 2010 Sep;32(3):451–453. https://doi.org/10.1093/pubmed/fdq057

8. Van Haren RM, Mehran RJ, Mena GE, Correa AM, Antonoff MB, Baker CM, et al. Enhanced Recovery Decreases Pulmonary and Cardiac Complications After Thoracotomy for Lung Cancer. Ann Thorac Surg. 2018 Jul;106(1):272–279. https://doi.org/10.1016/j.athoracsur.2018.01.088

9. Rogers LJ, Bleetman D, Messenger DE, Joshi NA, Wood L, Rasburn NJ, et al. The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer. J Thorac Cardiovasc Surg. 2018 Apr;155(4):1843–1852. https://doi.org/10.1016/j.jtcvs.2017.10.151

10. Khandhar SJ, Schatz CL, Collins DT, Graling PR, Rosner CM, Mahajan AK, et al. Thoracic enhanced recovery with ambulation after surgery: a 6-year experience. Eur J Cardiothorac Surg. 2018 Jun 1;53(6):1192–1198. https://doi.org/10.1093/ejcts/ezy061

11. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002 Jun;183(6):630–41. https://doi.org/10.1016/s0002-9610(02)00866-8

12. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008 Aug;248(2):189–198. https://doi.org/10.1097/SLA.0b013e31817f2c1a

13. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019 Jan 1;55(1):91–115. https://doi.org/10.1093/ejcts/ezy301

14. Egbert LD, Battit GE, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patients. a study of doctor-patient rapport. N Engl J Med. 1964 Apr 16;270:825–827. https://doi.org/10.1056/NEJM196404162701606

15. Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Søreide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011 Aug;28(8):556–569. https://doi.org/10.1097/EJA.0b013e3283495ba1

16. Gustafsson UO, Nygren J, Thorell A, Soop M, Hellström PM, Ljungqvist O, et al. Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand. 2008 Aug;52(7):946–951. https://doi.org/10.1111/j.1399-6576.2008.01599.x

17. Bilotta F, Lauretta MP, Borozdina A, Mizikov VM, Rosa G. Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013 Sep;79(9):1066–76.

18. Gee E. The National VTE Exemplar Centres Network response to implementation of updated NICE guidance: venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NG89). Br J Haematol. 2019 Sep;186(5):792–793. https://doi.org/10.1111/bjh.16010

19. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, 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. Chest. 2012 Feb;141(2 Suppl):e227S-e277S. https://doi.org/10.1378/chest.11-2297

20. van Dongen CJ, Mac Gillavry MR, Prins MH. Once versus twice daily LMWH for the initial treatment of venous thromboembolism. Cochrane Database Syst Rev. 2003;(1):CD003074. https://doi.org/10.1002/14651858.CD003074

21. Aznar R, Mateu M, Miró JM, Gatell JM, Gimferrer JM, Aznar E, et al. Antibiotic prophylaxis in non-cardiac thoracic surgery: cefazolin versus placebo. Eur J Cardiothorac Surg. 1991;5(10):515–518. https://doi.org/10.1016/1010-7940(91)90103-q

22. Bernard A, Pillet M, Goudet P, Viard H. Antibiotic prophylaxis in pulmonary surgery. A prospective randomized double-blind trial of flash cefuroxime versus forty-eight-hour cefuroxime. J Thorac Cardiovasc Surg. 1994 Mar;107(3):896–900.

23. Oxman DA, Issa NC, Marty FM, Patel A, Panizales CZ, Johnson NN, et al. Postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial. JAMA Surg. 2013 May;148(5):440–446. https://doi.org/10.1001/jamasurg.2013.1372

24. Schussler O, Alifano M, Dermine H, Strano S, Casetta A, Sepulveda S, et al. Postoperative pneumonia after major lung resection. Am J Respir Crit Care Med. 2006 May 15;173(10):1161–1169. https://doi.org/10.1164/rccm.200510-1556OC

25. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017 Aug 1;152(8):784–791. https://doi.org/10.1001/jamasurg.2017.0904

26. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD004122. https://doi.org/10.1002/14651858.CD004122.pub4

27. Pan A, Ambrosini L, Patroni A, Soavi L, Signorini L, Carosi G, et al. Adherence to surgical site infection guidelines in Italian cardiac surgery units. Infection. 2009 Apr;37(2):148–152. https://doi.org/10.1007/s15010-008-7474-8

28. Darouiche RO, Wall MJ, Itani KMF, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med. 2010 Jan 7;362(1):18–26. https://doi.org/10.1056/NEJMoa0810988

29. Galvão CM, Marck PB, Sawada NO, Clark AM. A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermia. J Clin Nurs. 2009 Mar;18(5):627–636. https://doi.org/10.1111/j.1365-2702.2008.02668.x

30. Madrid E, Urrútia G, Roqué i Figuls M, Pardo-Hernandez H, Campos JM, Paniagua P, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev. 2016 Apr 21;4:CD009016. https://doi.org/10.1002/14651858.CD009016.pub2

31. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006 May;83(5):1090–1104, 1107–1113. https://doi.org/10.1016/S0001-2092(06)60120-8

32. Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e278S-e313S. https://doi.org/10.1378/chest.12-2359

33. Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010 Feb;139(2):366–378. https://doi.org/10.1016/j.jtcvs.2009.08.026

34. Falcoz P-E, Puyraveau M, Thomas P-A, Decaluwe H, Hürtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg. 2016 Feb;49(2):602–609. https://doi.org/10.1093/ejcts/ezv154

35. Burt BM, Kosinski AS, Shrager JB, Onaitis MW, Weigel T. Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal. J Thorac Cardiovasc Surg. 2014 Jul;148(1):19–28. https://doi.org/10.1016/j.jtcvs.2014.03.007

36. Perna V, Carvajal AF, Torrecilla JA, Gigirey O. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg. 2016 Sep;50(3):411–5. https://doi.org/10.1093/ejcts/ezw161

37. Okur E, Baysungur V, Tezel C, Sevilgen G, Ergene G, Gokce M, et al. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg. 2009 Jan;35(1):32–35. https://doi.org/10.1016/j.ejcts.2008.09.009

38. Gómez-Caro A, Roca MJ, Torres J, Cascales P, Terol E, Castañer J, et al. Successful use of a single chest drain postlobectomy instead of two classical drains: a randomized study. Eur J Cardiothorac Surg. 2006 Apr;29(4):562–566. https://doi.org/10.1016/j.ejcts.2006.01.019

39. Refai M, Brunelli A, Salati M, Xiumè F, Pompili C, Sabbatini A. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg. 2012 Apr;41(4):820–822. https://doi.org/10.1093/ejcts/ezr126

40. Watanabe A, Watanabe T, Ohsawa H, Mawatari T, Ichimiya Y, Takahashi N, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg. 2004 May;25(5):872–876. https://doi.org/10.1016/j.ejcts.2004.01.041

41. Luckraz H, Rammohan KS, Phillips M, Abel R, Karthikeyan S, Kulatilake NEP, et al. Is an intercostal chest drain necessary after video-assisted thoracoscopic (VATS) lung biopsy? Ann Thorac Surg. 2007 Jul;84(1):237–239. https://doi.org/10.1016/j.athoracsur.2007.03.007

42. Ядута Р.Т., Качур А.К., Лядов В.К. Торакоскопические резекции легкого при метастатическом поражении без установки плеврального дренажа: начальный опыт. Хирургия. 2018;(4):68–70. https://doi.org/10.17116/hirurgia2018468-70

43. Matot I, Dery E, Bulgov Y, Cohen B, Paz J, Nesher N. Fluid management during video-assisted thoracoscopic surgery for lung resection: a randomized, controlled trial of effects on urinary output and postoperative renal function. J Thorac Cardiovasc Surg. 2013 Aug;146(2):461–466. https://doi.org/10.1016/j.jtcvs.2013.02.015

44. Zaouter C, Kaneva P, Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med. 2009 Dec;34(6):542–548. https://doi.org/10.1097/aap.0b013e3181ae9fac

45. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005 Apr;94(4):505–13. https://doi.org/10.1093/bja/aei085

46. Ong CKS, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010 Apr 1;110(4):1170–1179. https://doi.org/10.1213/ANE.0b013e3181cf9281

47. Assaad S, Kyriakides T, Tellides G, Kim AW, Perkal M, Perrino A. Extravascular Lung Water and Tissue Perfusion Biomarkers After Lung Resection Surgery Under a Normovolemic Fluid Protocol. J Cardiothorac Vasc Anesth. 2015 Aug;29(4):977–983. https://doi.org/10.1053/j.jvca.2014.12.020

48. Dull RO, Cluff M, Kingston J, Hill D, Chen H, Hoehne S, et al. Lung heparan sulfates modulate K(fc) during increased vascular pressure: evidence for glycocalyx-mediated mechanotransduction. Am J Physiol Lung Cell Mol Physiol. 2012 May 1;302(9):L816–828. https://doi.org/10.1152/ajplung.00080.2011

49. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia. 2016 Jan;71 Suppl 1:40–45. https://doi.org/10.1111/anae.13309

50. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017 Jun;36(3):623–650. https://doi.org/10.1016/j.clnu.2017.02.013

51. Singh BN, Dahiya D, Bagaria D, Saini V, Kaman L, Kaje V, et al. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy. Surg Endosc. 2015 Nov;29(11):3267–72. https://doi.org/10.1007/s00464-015-4071-7

52. Yavuz MS, Kazancı D, Turan S, Aydınlı B, Selçuk G, Özgök A, et al. Investigation of the effects of preoperative hydration on the postoperative nausea and vomiting. Biomed Res Int. 2014;2014:302747. https://doi.org/10.1155/2014/302747

53. Goodarzi M, Matar MM, Shafa M, Townsend JE, Gonzalez I. A prospective randomized blinded study of the effect of intravenous fluid therapy on postoperative nausea and vomiting in children undergoing strabismus surgery. Paediatr Anaesth. 2006 Jan;16(1):49–53. https://doi.org/10.1111/j.1460-9592.2005.01693.x

54. Elia N, Lysakowski C, Tramèr MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005 Dec;103(6):1296–304. https://doi.org/10.1097/00000542-200512000-00025

55. Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg. 2014 Feb;45(2):241–246. https://doi.org/10.1093/ejcts/ezt376

56. Sihoe ADL. Clinical pathway for video-assisted thoracic surgery: the Hong Kong story. J Thorac Dis. 2016 Feb;8(Suppl 1):S12–22. https://doi.org/10.3978/j.issn.2072-1439.2016.01.75

57. Preventza O, Hui HZ, Hramiec J. Fast track video-assisted thoracic surgery. Am Surg. 2002 Mar;68(3):309–311

58. Malik M, Black EA. Fast-track video-assisted bullectomy and pleurectomy for pneumothorax: initial experience and description of technique. Eur J Cardiothorac Surg. 2009 Nov;36(5):906–909. https://doi.org/10.1016/j.ejcts.2009.05.023

59. Huang H, Ma H, Chen S. Enhanced recovery after surgery using uniportal video-assisted thoracic surgery for lung cancer: A preliminary study. Thorac Cancer. 2018 Jan;9(1):83–87. https://doi.org/10.1111/1759-7714.12541

60. Brunelli A, Thomas C, Dinesh P, Lumb A. Enhanced recovery pathway versus standard care in patients undergoing video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg. 2017 Dec;154(6):2084–2090. https://doi.org/10.1016/j.jtcvs.2017.06.037


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Качур А.К., Лядов В.К. Основные компоненты протокола ускоренного выздоровления в хирургии опухолей легкого. Research'n Practical Medicine Journal. 2021;8(3):70-83. https://doi.org/10.17709/2410-1893-2021-8-3-7

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Каchur A.K., Lyadov V.K. Key components of enhanced recovery after surgery protocol in lung cancer surgery. Research and Practical Medicine Journal. 2021;8(3):70-83. (In Russ.) https://doi.org/10.17709/2410-1893-2021-8-3-7

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