Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship betwee...Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.展开更多
1文献来源
Luketich JD,Pennathur A,Awais O,et al.Outcomes after minimally invasive esophagectomy：Review of over 1000 patients[J].Ann Surg,2012,256（1）：95-103.
1文献来源
Smithers BM,Gotley DC,Martin I,et al.Comparison of the outcomes between open andminimally invasive esophagectomy[J].Ann Surg,2007,245（2）：232-240.
2证据水平
2b。
3背景
·外科手术是食管癌治疗的金标...1文献来源
Smithers BM,Gotley DC,Martin I,et al.Comparison of the outcomes between open andminimally invasive esophagectomy[J].Ann Surg,2007,245（2）：232-240.
2证据水平
2b。
3背景
·外科手术是食管癌治疗的金标准,微创食管切除可能可以避免开胸手术并发症,提供了一种有潜力的治疗选择。
·目前尚未明确胸腔镜辅助术式或全微创食管癌术式与传统开放术式相比是否具有优势。展开更多
Esophageal cancer(EC)is among the most common malignances and one of the leading causes of cancer-related death worldwide.Surgery plays a significant role in the multidisciplinary treatment for esophageal cancer.Recen...Esophageal cancer(EC)is among the most common malignances and one of the leading causes of cancer-related death worldwide.Surgery plays a significant role in the multidisciplinary treatment for esophageal cancer.Recent advances in minimally invasive esophagectomy(MIE),including conventional thoracoscopic surgery and more recent robotic surgery,has been shown to improve short-term outcomes compared to open surgery.Robot-assisted minimally invasive esophagectomy(RAMIE)was first performed in 2003 and has been increasingly utilized in tertiary medical centers.Compared to conventional video-assisted minimally esophagectomy(VAMIE),RAMIE provides certain advantages such as increased magnification,three-dimensional visual clarity and better lymphadenectomy,with superior short-term outcome and at least equivalent oncological results.This review focuses on the techniques,benefits and obstacles in applications of robotic esophagectomy for treating EC,meanwhile discussing the future of robotic esophageal surgery.展开更多
Objective To investigate the feasibility and safety of early removal of gastric tube and thoracic drainage tube after minimally invasive esophagectomy.Methods A retrospective analysis was performed on 93 patients unde...Objective To investigate the feasibility and safety of early removal of gastric tube and thoracic drainage tube after minimally invasive esophagectomy.Methods A retrospective analysis was performed on 93 patients undergoing thoraco-laparoscopic assisted esophagectomy between January 2022 and September 2022.All patients were divided into two groups,the early group and the conventional group.The differences in drainage volume on the first day after operation,days of thoracic drainage tube indwelling,thoracic drainage tube replacement,incidence rate of pleural effusion,atelectasis,pneumothorax as well as pulmonary infection,respiratory insufficiency,and postoperative hospital stay were compared between the two groups.The criteria for thoracic drainage tube removal is the daily thoracic drainage volume of less than 250 ml in the early group.The gastric fluid volume on the first day after operation,the number of days of gastric tube indwelling,the rate of gastric tube replacement after removal,and the time of intestinal exhaust were compared between the two groups.In the meantime,the incidence of complications,such as anastomotic leakage and pulmonary infection,was observed in the two groups.Results The removal time of gastric tube and thoracic drainage tube was significantly earlier in the early group than in the control group(P<0.05).There was no significant difference in the gastric fluid volume and pleural fluid between the early group and the conventional group(P>0.05),but there were significant differences in postoperative anastomotic leakage between the two groups(P<0.05).There was no significant difference in the incidence of pleural effusion,atelectasis,pneumothorax,and pulmonary infection(P>0.05),nor in thoracentesis rate and gastric tube replacement(P>0.05).The postoperative hospital stay was significantly shorter in the early group than in the conventional group(P<0.05)Conclusion The early removal of the thoracic drainge tube and gastric tube is safe and effective,which does not increase the incidence of postoperative complications.展开更多
文摘Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.
文摘1文献来源
Luketich JD,Pennathur A,Awais O,et al.Outcomes after minimally invasive esophagectomy：Review of over 1000 patients[J].Ann Surg,2012,256（1）：95-103.
文摘1文献来源
Smithers BM,Gotley DC,Martin I,et al.Comparison of the outcomes between open andminimally invasive esophagectomy[J].Ann Surg,2007,245（2）：232-240.
2证据水平
2b。
3背景
·外科手术是食管癌治疗的金标准,微创食管切除可能可以避免开胸手术并发症,提供了一种有潜力的治疗选择。
·目前尚未明确胸腔镜辅助术式或全微创食管癌术式与传统开放术式相比是否具有优势。
基金National Natural Science Foundation of China(81871882)Shanghai Municipal Commission of Health and Family Planning Outstanding Academic Leaders Training Program(2017BR055)Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant(20172005).
文摘Esophageal cancer(EC)is among the most common malignances and one of the leading causes of cancer-related death worldwide.Surgery plays a significant role in the multidisciplinary treatment for esophageal cancer.Recent advances in minimally invasive esophagectomy(MIE),including conventional thoracoscopic surgery and more recent robotic surgery,has been shown to improve short-term outcomes compared to open surgery.Robot-assisted minimally invasive esophagectomy(RAMIE)was first performed in 2003 and has been increasingly utilized in tertiary medical centers.Compared to conventional video-assisted minimally esophagectomy(VAMIE),RAMIE provides certain advantages such as increased magnification,three-dimensional visual clarity and better lymphadenectomy,with superior short-term outcome and at least equivalent oncological results.This review focuses on the techniques,benefits and obstacles in applications of robotic esophagectomy for treating EC,meanwhile discussing the future of robotic esophageal surgery.
文摘Objective To investigate the feasibility and safety of early removal of gastric tube and thoracic drainage tube after minimally invasive esophagectomy.Methods A retrospective analysis was performed on 93 patients undergoing thoraco-laparoscopic assisted esophagectomy between January 2022 and September 2022.All patients were divided into two groups,the early group and the conventional group.The differences in drainage volume on the first day after operation,days of thoracic drainage tube indwelling,thoracic drainage tube replacement,incidence rate of pleural effusion,atelectasis,pneumothorax as well as pulmonary infection,respiratory insufficiency,and postoperative hospital stay were compared between the two groups.The criteria for thoracic drainage tube removal is the daily thoracic drainage volume of less than 250 ml in the early group.The gastric fluid volume on the first day after operation,the number of days of gastric tube indwelling,the rate of gastric tube replacement after removal,and the time of intestinal exhaust were compared between the two groups.In the meantime,the incidence of complications,such as anastomotic leakage and pulmonary infection,was observed in the two groups.Results The removal time of gastric tube and thoracic drainage tube was significantly earlier in the early group than in the control group(P<0.05).There was no significant difference in the gastric fluid volume and pleural fluid between the early group and the conventional group(P>0.05),but there were significant differences in postoperative anastomotic leakage between the two groups(P<0.05).There was no significant difference in the incidence of pleural effusion,atelectasis,pneumothorax,and pulmonary infection(P>0.05),nor in thoracentesis rate and gastric tube replacement(P>0.05).The postoperative hospital stay was significantly shorter in the early group than in the conventional group(P<0.05)Conclusion The early removal of the thoracic drainge tube and gastric tube is safe and effective,which does not increase the incidence of postoperative complications.
