ABSTRACT
Objective@#To investigate the effect of nursing intervention on information-motivation-behavioral skill (IMB) model in patients with adjuvant chemotherapy after radical resection of upper thoracic esophageal squamous cell carcinoma.@*Methods@#A total of 128 patients with adjuvant chemotherapy after radical resection of esophageal squamous cell carcinoma from December 2016 to June 2018 were enrolled. The random number table method was used to divide them into control group (64 cases) and study group (64 cases). The control group received routine nursing, and the study group took the IMB model of nursing intervention on the basis of the control group. The intervention time was 2 months. Postoperative rehabilitation (feeding time, time to get out of bed, and length of hospital stay), pre-intervention self-efficacy score (Strategies Used by People to Promote Health, SUPPH), European Organization for Research and Treatment of Cancer-Quality of Life-Core 30 Questionnaire (EORTC-QLQ-C30), complications (reflux esophagitis, chest cavity), the incidence of effusion, infection, anastomotic leakage, and satisfaction of nursing work were compared.@*Results@#The feeding time of the study group was (3.39±0.72) d, the time of getting out of bed (2.26±1.02) d, the length of hospital stay (9.19±1.68) d, which was shorter than that of the control group (4.48±0.81), (4.07±1.55), (12.26±2.35) d, the difference was statistically significant (t=8.046, 7.804, 8.502, P<0.05). After intervention, the self-decision, self-decompression, and positive attitude scores of the two groups were higher than those before the intervention, and the study group was (11.19±1.28), (28.37±2.79), (39.98±5.01), respectively, higher than the control group. The differences were statistically significant (t= 7.239, 5.036, 5.057, P < 0.05). After intervention, the social function, emotional function, role function and physical function score of the two groups were higher than those before the intervention, and the study group were (69.02±6.87), (70.61±7.65), (69.68±6.80), (72.55±6.51). The scores were higher than those of the control group (61.13±7.03), (63.64±7.44), (60.22±7.05), and (65.86±6.08), and the difference was statistically significant (t=5.225-6.422, P<0.05). The complication rate was 7.81% (5/64) in the study group and 20.31% (13/64) in the control group. The difference was statistically significant (χ2=4.137, P <0.05). The nursing job satisfaction of the study group was 92.19% (59/64), which was higher than that of the control group 79.69% (51/64). The difference was statistically significant (χ2=4.137, P<0.05).@*Conclusions@#The intervention of IMB model in the treatment of patients with adjuvant chemotherapy after radical resection of upper esophageal squamous cell carcinoma can effectively improve their self-efficacy, reduce postoperative complications, shorten the postoperative rehabilitation time, and improve the quality of life of patients and improve the satisfaction of their nursing work.
ABSTRACT
Objective To investigate the effect of nursing intervention on information-motivation-behavioral skill (IMB) model in patients with adjuvant chemotherapy after radical resection of upper thoracic esophageal squamous cell carcinoma. Methods A total of 128 patients with adjuvant chemotherapy after radical resection of esophageal squamous cell carcinoma from December 2016 to June 2018 were enrolled. The random number table method was used to divide them into control group (64 cases) and study group (64 cases). The control group received routine nursing, and the study group took the IMB model of nursing intervention on the basis of the control group. The intervention time was 2 months. Postoperative rehabilitation (feeding time, time to get out of bed, and length of hospital stay), pre-intervention self-efficacy score (Strategies Used by People to Promote Health, SUPPH), European Organization for Research and Treatment of Cancer-Quality of Life-Core 30 Questionnaire (EORTC-QLQ-C30), complications (reflux esophagitis, chest cavity), the incidence of effusion, infection, anastomotic leakage, and satisfaction of nursing work were compared. Results The feeding time of the study group was (3.39±0.72) d, the time of getting out of bed (2.26±1.02) d, the length of hospital stay (9.19±1.68) d, which was shorter than that of the control group (4.48±0.81), (4.07±1.55), (12.26±2.35) d, the difference was statistically significant (t=8.046, 7.804, 8.502, P<0.05). After intervention, the self-decision, self-decompression, and positive attitude scores of the two groups were higher than those before the intervention, and the study group was (11.19±1.28), (28.37±2.79), (39.98±5.01), respectively, higher than the control group. The differences were statistically significant (t=7.239, 5.036, 5.057, P<0.05). After intervention, the social function, emotional function, role function and physical function score of the two groups were higher than those before the intervention, and the study group were (69.02 ± 6.87), (70.61 ± 7.65), (69.68±6.80), (72.55±6.51). The scores were higher than those of the control group (61.13±7.03), (63.64±7.44), (60.22±7.05), and (65.86±6.08), and the difference was statistically significant (t=5.225-6.422, P<0.05). The complication rate was 7.81% (5/64) in the study group and 20.31% (13/64) in the control group. The difference was statistically significant (χ2=4.137, P<0.05). The nursing job satisfaction of the study group was 92.19% (59/64), which was higher than that of the control group 79.69% (51/64). The difference was statistically significant (χ2=4.137, P<0.05). Conclusions The intervention of IMB model in the treatment of patients with adjuvant chemotherapy after radical resection of upper esophageal squamous cell carcinoma can effectively improve their self-efficacy, reduce postoperative complications, shorten the postoperative rehabilitation time, and improve the quality of life of patients and improve the satisfaction of their nursing work.
ABSTRACT
Objective To describe the effects of surgical intervention on the prognosis in non-small-cell lung cancer patients with pleural carcinomatosis detected at thoracotomy.Methods Retrospectively analyzed clinical data from 54 patients who have unexpected malignant pleural nodules and/or malignant pleural effusions first detected at thoracotomy from January 2009 and December 2013.The effects of surgical intervention on the prognosis were also discussed.Results Sixteen cases had only biopsy,whereas 38 (70.4％) cases had primary tumor resection.The median survival time of 54 patients with pleural carcinomatosis were 23 months.The overall 1 and 5-year survival rates were 64％ and 18％,respectively.Primary tumor resection had significantly better outcome compared with biopsy(MST:respectively,24 vs 15 months,5-year survival rate 39％ vs 6％,P ＜0.05).Univariate analysis showed that primary tumor resection,no smoking history,lower T and N stage has favorable survival(P ＜ 0.05).Multivariate analysis showed that the best N stage(P =0.002) and adenocarcinoma(P =0.035) were favorable prognostic factors in these patients.Conclusion For patients with pleural careinomatosis first detected at thoracotomy,limited primary tumor resection may have survival benefits,lower T and N stage for them was associated with better survival.
ABSTRACT
Objective To describe the effects of surgical intervention on the prognosis in non-small-cell lung cancer patients with pleural carcinomatosis detected at thoracotomy.Methods Retrospectively analyzed clinical data from 54 patients who have unexpected malignant pleural nodules and/or malignant pleural effusions first detected at thoracotomy from January 2009 and December 2013.The effects of surgical intervention on the prognosis were also discussed.Results Sixteen cases had only biopsy,whereas 38 (70.4％) cases had primary tumor resection.The median survival time of 54 patients with pleural carcinomatosis were 23 months.The overall 1 and 5-year survival rates were 64％ and 18％,respectively.Primary tumor resection had significantly better outcome compared with biopsy(MST:respectively,24 vs 15 months,5-year survival rate 39％ vs 6％,P ＜0.05).Univariate analysis showed that primary tumor resection,no smoking history,lower T and N stage has favorable survival(P ＜ 0.05).Multivariate analysis showed that the best N stage(P =0.002) and adenocarcinoma(P =0.035) were favorable prognostic factors in these patients.Conclusion For patients with pleural careinomatosis first detected at thoracotomy,limited primary tumor resection may have survival benefits,lower T and N stage for them was associated with better survival.
ABSTRACT
Objective To evaluate the short?term efficacy and safety of endoscopic photodynamic therapy ( PDT ) for esophageal squamous cell carcinoma ( ESCC ) and precancerous lesion. Methods Retrospective analysis was performed on 30 patients with early ESCC or precancerous lesions who received PDT between September 2013 and April 2015 in Endoscopy Center, Henan Tumor Hospital,and its indications were summarized. The main outcomes including histological complete response rate ( CR ) , recurrence rate and adverse events after treatment of one year were analyzed. Results Three patients with middle grade dysplasia( MGD) , 18 with high grade dysplasia( HGD) and 4 with squamous cell carcinoma in situ, all negative lymph node metastasis, received PDT. CRs were 72?0%(18/25) and 88?0%(22/25)after one PDT session in 3 months and 12 months, respectively. One?year follow?up showed 3 recurrences ( 12?0%) ,4 ( 16?0%) severe strictures, and no perforation. Five patients with advanced squamous cell carcinoma received palliative PDT. Partial remission rate was 60?0%( 3/5) after one PDT session in 3 months, and 40?0% ( 2/5) after 12 months. Two died of tumor metastasis, one died of gastrointestinal bleeding one year after PDT. No perforation occurred. Conclusion Endoscopic photodynamic therapy for esophageal squamous cell carcinoma and precancerous lesions is safe and feasible, with remarkable short?term effect. As for the patients with advanced squamous cell carcinoma, it is equally safe and effective in the short term.
ABSTRACT
Objective To investigate the application value and feasibility of enhanced recovery after surgery (ERAS) in thoracoscopic and laparoscopic esophagectomy for esophageal cancer.Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed.All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia.The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group.Observing indicators included : (1) enteral and parenteral nutritional support treatments;(2) nutrient indexs: levels of serum albumin (Alb) and prealbumin;(3) the recovery of gastrointestinal function: time to anal exsufflation and defecation;(4) postoperative complications and the grading according to Clavien standard;(5) duration of postoperative hospital stay and treatment expenses;(6) risk factors affecting postoperative complications by multivariate analysis;(7) independent risk factors affecting occurrence rate of postoperative complications by univariate analysis.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Nonnormal distribution data were analyzed by the Wilcoxon rank sum test.Comparison of repeated data was analyzed by the repeated measures ANOVA.Categorical variables were analyzed using the chi-square test or Fisher's exact probability.The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively.Results (1) During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn't receive oral intake at postoperative day 1,26 proceeded the intravenous rehydration at postoperative day 4 due to calorie intake less than 80％ of calorie requirement, and enteral nutritional support treatment was well-tolerated in the control group.(2) Comparison of nutrient indexs : the levels of serum Alb and prealbumin at postoperative day 1, 3 and 5 were (37.2±3.9)g/L, (39.1 ±3.5)g/L, (38.5 ±3.0)g/L and (0.20 ±0.06)g/L, (0.13 ±0.04)g/L, (0.13 ±0.04)g/L in the ERAS group, (37.7 ±2.8)g/L, (39.0 ±3.6)g/L, (38.4 ±3.8)g/L and (0.18 ± 0.06) g/L, (0.13 ± 0.04) g/L, (0.13 ± 0.04) g/L in the control group, respectively, showing no significant difference in the postoperative changing trends between the 2 groups (F =0.357, 0.453, P ＞ 0.05).(3) The recovery of gastrointestinal function : time to first anal exsufflation and first defecation were (2.1 ± 0.8) days and (3.4 ± 1.2) days in the ERAS group, (3.2 ± 0.9) days and (5.5 ± 1.5) days in the control group, respectively,showing significant differences between the 2 groups (t =-10.505,-13.174, P ＜0.05).(4) There was no death in the perioperative period.The overall incidences of postoperative complications and number of patients with severe complications were 26.15％ (51/195) and 8 in the ERAS group, 30.28％ (33/109) and 8 in the control group, with no significant difference between the 2 groups (x2=0.594, 1.469, P ＞ 0.05).Eight and 10 patients in the ERAS and control groups underwent gastrointestinal decompression, 6 and 8 patients in the ERAS and control groups underwent retreatment in the intensive care unit (ICU), 3 and 2 patients in the ERAS and control groups were readmitted to the hospital at 3 weeks after discharge, with no significant difference in the above indexes (x2=0.185, 2.892, P ＞0.05).(5)The duration of postoperative hospital stay and treatment expenses were (6.8 ±2.4)days and (25 088 ±10 336)yuan in the ERAS group, (11.1 ±3.4)days and (38 819± 14 854)yuan in the control group, showing significant differences between the 2 groups (t =-12.782,-9.452,P ＜ 0.05).(6) The age, gender, preoperative weight loss ＞ 10％, tumor staging, tumor differentiation,neoadjuvant chemotherapy and time of food intake were risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the univariate analysis (x2=2.484, 2.333, 0.061, 8.553,2.459, 0.163, 3.462, P ＜ 0.05).(7) The age, preoperative weight loss ＞ 10％, tumor staging and neoadjuvant chemotherapy were independent risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the multivariate analysis (OR =0.365, 10.761,0.290, 8.140, 95％ confidence interval :0.198-0.671, 4.122-28.095, 0.130-0.645, 3.946-16.791, P ＜0.05), but time of food intake was not an independent risk factor (OR =0.540, 95％ CI: 0.280-1.041, P ＞ 0.05).Conclusions ERAS in the esophageal minimally invasive surgery for esophageal cancer is safe and feasible, with the advantages of shorter recovery time of gastrointestinal function and duration of hospital stay, lower treatment expenses and a better application value compared with traditional treatment.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility of no nasogastric intubation and early oral feeding at will after thoracolaparoscopic esophagectomy for patients with esophageal cancer.</p><p><b>METHODS</b>Between January 2013 and January 2014, the feasibility of no nasogastric intubation and early oral feeding at postoperative day(POD) 1 after thoracolaparoscopic esophagectomy was prospectively investigated in 156 patients (trial group) with esophageal cancer in the Henan Cancer Hospital. One hundred and sixty patients previously managed in the same unit who were treated routinely after thoracolaparoscopic esophagectomy were served as control group.</p><p><b>RESULTS</b>Of 156 patients of trial group, 6(3.8%) patients could not take food early as planned because of postoperative complications. The overall complication rate in trial group was 19.2%(30/156), which was 25.0%(30/160) in control group (P=0.217). The anastomotic leakage in trial group and control group was 2.6%(4/156) and 4.3%(7/160) respectively (P=0.380). Compared with control group, time to first flatus [(2.1±0.9) d vs. (3.3±1.1) d, P<0.001], bowel movement [(4.4±1.3) d vs. (6.6±1.0) d, P<0.001] and postoperative hospital stay [(8.3±3.2) d vs. (10.4±3.6) d, P<0.001] were significantly shorter in trial group.</p><p><b>CONCLUSIONS</b>No nasogastric intubation and early oral feeding postoperatively in patients with thoracolaparoscopic esophagectomy is feasible and safe. This management can shorten postoperative hospital stay and fasten postoperative bowel function recovery.</p>
Subject(s)
Humans , Eating , Esophageal Neoplasms , General Surgery , Esophagectomy , Fasting , Feasibility Studies , Intubation, Gastrointestinal , Postoperative Complications , Postoperative PeriodABSTRACT
The present study was to develop and design a new sonography rigid bronchoscopy and corollary vacuum-assisted biopsy device system with less injury and complication. The system combined ultrasonic-probe with ultrasound catheter, a new medical ultrasound technique, and rigid bronchoscopy (RB) which is improved with an auxiliary vacuum-assisted biopsy device. The principle of the device is vacuum suction and rotary knife. The reduced outer diameter of the RB led to less pain and lower complications for the patient. With the help of ultrasonic-probe (30 MHz), lesions and blood vessels can be identified clearly and unintentional puncture and damage to blood vessels can be avoided. Plenty of lesions can be obtained quickly through the vacuum-assisted biopsy device without getting puncture needle in and out repeatedly. The novel endobronchial sonography rigid bronchoscopy and matched vacuum-assisted biopsy device has many remarkable advantages. It can enlarge the applied range of the RB from endobronchial to mediastinal lesions, avoiding unintentional puncture of vessels. Obtaining multiple samples with a higher accuracy rate than that by other sampling techniques, minimizing operation time, alleviating pain and decreasing the complication rate, the system makes up the technical deficiency for the diagnosis and treatment of the mediastinal lesions, to a certain degree.
Subject(s)
Humans , Biopsy, Needle , Bronchoscopy , Equipment Design , Mediastinum , Pathology , Ultrasonography , VacuumABSTRACT
Objective:To compare three different routes for nutritional support after thoracolaparoscopic esophagectomy. Meth-ods:The clinical data of 310 esophageal cancer patients undergoing thoracolaparoscopic esophagectomy in Affiliated Cancer Hospital of Zhengzhou University from January 2010 to October 2013 were analyzed (early oral feeding group:110, nasojejunal tube feeding group:102, and jejunostomy tube feeding group:98). The serum albumin and body weights were compared among the three groups be-fore operation and four days after operation. The postoperative recovery time of the first exhaust time and hospitalization days were al-so compared. The fistula of esophageal anastomosis, pulmonary infection, and complications from intubation such as throat inflamma-tion were also compared. Results:No postoperation mortality occurred in the three groups. In addition, no significant difference was ob-served between the nasojejunal tube group and jejunostomy group for the first exhaust time and hospitalization days. The recovery of the early oral feeding group was significantly faster than the other two groups. Postoperative acute dilatation of the stomach and func-tional delayed gastric emptying were not found in the three groups. The anastomotic leakage and pulmonary infection rate had no signif-icant difference. The throat inflammation from intubation in the nasojejunal tube feeding group was significantly more than that in the jejunostomy tube feeding group. Eleven percent of the patients removed the tube by themselves. In the jejunostomy tube feeding group, five patients suffered from postoperative fistula drainage, including one case with serious symptoms. Five patients had incomplete ileus. Conclusion:Early oral feeding is a suitable nutritional support route after thoracolapascopic esophagectomy and it is a good way to re-duce operation stress, improve patient compliance, induce fast recovery, and shorten hospitalization days.
ABSTRACT
Objective To compare the safety,feasibility,and long-term outcomes between combined thoracoscopic and laparoscopic esophagectomy (TLE) and open three-field esophagectomy (OE) for esophageal cancer.Methods The data of 183 patients with esophageal cancer who accepted TLE (n =94) or OE (n =89) from February 2009 to December 2011 were retrospectively collected and compared.Results Demographics,pathologic data in each cohort were almost identical.No significant differences were observed in operative time,the number of lymph node harvested,rates of anastomotic leak,thoracic abscess,chyle chest,re-operation,vocal cord paralysis,gastric emptying dysfunction and morbidity.A significant difference was observed in blood loss (86.6 ±38.3 ml in TLE group vs.217.4 ±87.2 ml in OE group,P=0.000),rate of transfusion (1.1％ vs.6.7％,P =0.045),hospital stay (13.9 ±7.5 d vs.17.1 ±10.2 d,P =0.017),rate of overall surgical complications (23.4％ vs.38.2％,P =0.030),rate of pulmonary complications (9.6％ vs.27.0％,P =0.002) and rate of arythmia (4.1％ vs.12.4％,P =0.046).Median follow-up time was 28.0 ±2.0 months (95％ CI:24.2-31.8).No difference between the two groups concerning survival was observed (P =0.954).Conclusion The TLE for esophageal cancer is safe and feasible.Although it cannot improve the survival of long-term,it is worth spreading in intraoperative and postoperative advantages compared with OE group.
ABSTRACT
Objective To compare the outcomes between modified McKeown minimally invasive approach and open left chest-neck incision approach esophagectomy for treatment cancer of mid-to-distal thoracic esophagus.Methods We retrospectively analyzed clinical data from 128 patients with mid-to-distal thoracic esophageal cancer who underwent thoracoscopic and laparoscopic esophagectomy from March 2009 to March 2012.One hundred and fifty patients were served as control that underwent open left chest-neck incision approach esophagectomy in the same period.Results All the operations were performed successfully.There was significant difference between modified McKeown minimally invasive approach and open left chest-neck incision approach esophagectomy with regard to respiratory complications (10.9 ％ vs.20.7％),pneumonia (4.7％ vs.11.3 ％),atelectasis (3.1％ vs.10.5 ％,),pleural effusion (3.1％ vs.10.0％) and delayed gastric emptying (8.6 ％ vs.1.3 ％) (P ＜ 0.05).Hospital stay was significantly shorter in the minimally-invasive group than the open group [(11.7 ± 3.6) days vs.(13.9 ± 6.5) days,P＜0.05],and had significantly less blood loss [(88.1 ±41.8) ml vs.(360.5 ±80.6) ml,P＜0.05] and the number of lymph nodes harvested (22.9 ±5.7 vs.16.8 ±4.5,P ＜0.05).No significant differences were observed on the operative time,mortality and other complication between the two groups.Conclusion Modified McKeown minimally invasive approach esophagectomy is techeniqually feasible and safely which have lower blood loss,lower respiratory complication,shorter hospital stay and more number of lymph nodes harvested comparing to open left chest-neck incision approach.
ABSTRACT
By studying the behaviors of surfing in the Internet of the readers in our electronic reading room,we find a majority of readers are for amusement,only a minority of readers are to study and search data.Aiming at these problems,we put forward a series of measures and management countermeasures that guide readers to make good use of the electronic reading room and give some suggestions for our future work.
ABSTRACT
AIM: To study the change of cellular immunological function in patients with locally advanced lung cancer before and after operations. METHODS: A lung cancer group of 20 cases with locally advanced lung cancer (group A), a benign disease group of 20 cases with lung benign disease (group B) and a normal group of 20 cases from healthy volunteers (group C) were set up. The levels of the peripheral blood T lymphocyte subsets (CD~+_3, CD~+_4, CD~+_8, CD~+_4/ CD~+_8 ratio) were detected in the group A before operation and on the 10th day and 17th day after operation by indirect immuno-fluorescence assay and contrasted with the group B and group C. RESULTS: The levels of T lymphocyte subsets in group A were abnormal before operation, CD~+_3, CD~+_4/ CD~+_8 ratio were significantly lower than those in group B and group C (P
ABSTRACT
The effects of tetramethylpyrazine ( TMPZ ) on the contraction of isolated guinea pig trachea induced by leukotrienes,histamine,prostagladin F2a , acetylcholine were observed. It was found that TMPZ exerts an inhibitory effect on the contraction induced by these asthmogenic mediators. It is non-competitive antagonist.