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Objective:To compare the effects of three heating methods on intraoperative temperature and postoperative resuscitation in patients undergoing three-incision radical resection of esophageal cancer under full endoscope.Methods:A total of 145 patients undergoing endoscopic three-incision radical resection of esophageal cancer were randomized to receive forced-air warming respectively on the under-body blanket(UB group, n=48), over-body blanket (OB group, n=48), underbody blanket in combination with over-body blanket(Combined group, n=49). The nasopharyngeal temperature were recorded at the time of entering the operating room, at the beginning of the intubation, at the beginning of the operation and every 30min after the operation, at the end of the operation. The incidence of hypothermia, hypothermia related adverse reactions and postoperative resuscitation indicators of the three groups were compared. Results:During the operation, the patients' temperature fluctuation showed two processes of decrease and two processes of increase. The temperature of Combined group showed a lower fall and a faster rise. The average temperature of the Combined group were higher than the other two group at each time point from the beginning of the intubation, the incidence of hypothermia was 4.08% (2/49), which was lower than the OB group [22.92% (11/48)] and the UB group [18.75% (9/48)], The difference was statistically significant ( χ2 value was 7.397, P=0.025). The temperature of the UB group was (36.52±0.18),(36.31±0.35)℃ at the beginning of intubation and at the end of the operation, respectively, which were higher than that of the OB group (36.44±0.15),(36.13±0.32)℃ ( t value was 2.393, 3.723, P < 0.05). The temperature comfort score of the combined group was 7.81±0.52, higher than that of the other two groups ( F value was 19.962, P<0.01), and the scores of chills, agitation and chills in the recovery period were lower than that of the other two groups ( F value was 8.186, 6.705, 4.051, all P < 0.05). The extubation time and the waking time of the combined group was (15.90±2.97)min, (31.47±4.42)min, respectively, which were both lower than those of the other two groups ( F value was 69.094, 114.549, P < 0.01). Conclusions:In endoscopic three-incision radical resection of esophageal cancer, combined heating makes the patients' temperature rise rapidly to offset the loss of heat, which is conducive to maintain a stable temperature. At the same time, the incidence of intraoperative hypothermia, postoperative chills and agitation is reduced, the temperature comfort of patients is improved, the extubation time and waking time are shortened, which is conducive to promote postoperative recovery of patients, thus reduce postoperative hypothermia related complications.
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Objective To explore the effects of modified herringbone-Trendelenburg position in the laparoscopic anterior resection for rectal cancer patients. Methods A total of 108 patients undergoing laparoscopic anterior resection were recruited and randomly assigned to observation group(54 cases) and control group (54 cases). Patients in the observation group were positioned in modified herringbone-Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate (HR), mean arterial pressure (MAP) were recorded at 3minutes before body position change and 3 minutes after body position change, 3 minutes before recover horizontal position and 3 minutes after recover horizontal position. Intraocular pressure (IOP) were measured at 3 minutes after general anesthesia in supine position (T0), and 3 minutes after pneumoperitoneum while in the operation position (T1), every 1 hour (T2 to T3), 3 minutes before recover horizontal position at the end of pneumoperitoneum (T4), 3 minutes after recover horizontal position (T5) and 30 minutes after recover horizontal position(T6). Investigate the satisfaction of the surgeons regarding the surgical position of the patients.Followed up investigation at 24h and 48h after surgery were enforced to record the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results The heart rate pre-and post the change of body position in observation group were (2.11±0.92), (-2.78±1.01) beats/min respectively, while the control group were (5.98±2.98), (-6.03±1.98) beats/min, the differences were statically significant (t=9.111,9.851, P<0.01).The mean arterial pressure pre-and post the change of body position in observation group were (1.67 ± 1.23), (2.21 ± 0.89) mmHg(1mmHg=0.133kPa) respectively, while the control group were (7.20±2.30), (6.41±1.87)mmHg, the differences were statically significant(t=15.512, 14.811, P<0.01).The differences of intra-ocular pressure between 2 groups had no statistical significance at T0 and T6 (P>0.05). The intra-ocular pressure were (13.64±1.66), (16.56±1.82),(19.78±1.70),(21.00±1.71),(18.53±1.77)mmHg respectively from T1 to T5, lower than that of control group (15.59±2.03),(19.40±1.89), (23.22±2.15), (25.38±2.09), (22.35±1.76)mmHg, the differences were statically significant (t=5.442-11.907, P<0.01).The incidence of shoulder pain and low leg pain in observation group were 9.26％(5/54), 7.41％(4/54) respectively, lower than that of control group 46.29％(25/54),31.48％(17/54), the differences were statically significant (t=17.778,9.755,P<0.01). The scores of shoulder pain and low leg pain in observation group were (1.38±0.38), (2.02±0.34) points, lower than that of control group (4.44 ± 0.48), (3.85 ± 0.57) points, the differences were statically significant (t=36.761, 20.162, P<0.01). The satisfaction rate of surgeons was 87.04％(47/54) in the observation group, higher than that in the control group 55.56％ (30/54), the difference was statically significant (χ2=5.119, P=0.024). Conclusion Modified herringbone-Trendelenburg position can maintain the circulatory system stability better without affecting the operation, reduce the elevation of IOP, effectively improve the comfort of the operation position of the patients,reduce the postoperative complications of the lower limbs and the incidence rate of the shoulder pain in the laparoscopic anterior resection for rectal cancer patients.
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Objective To introduce the application and the surgical cooperation of the transanal endoscopic microsurgery in resection of rectal neoplasms and summarize the nursing points.Method The clinical histories of 135 patients undergoing resection of rectal neoplasms with transanal endoscopic microsurgery were reviewed and analyzed.Results All the surgeries were successful. Four patients developed with wound infections,three of them getting better after treatment and one of them diagnosed with poorly differentiated adenocarcinoma and selected another operation.Conclusion Well-prepared、pre-operation,skillful operation and instrument procedure and postoperative nursing were critical to the success of operations.