综述

食管癌围手术期的物理治疗进展

  • 王龙平 ,
  • 曾斌 ,
  • 白文芳 ,
  • 邓澄 ,
  • 吴映红 ,
  • 乔贵宾
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  • 1.广东省人民医院,广东省医学科学院康复医学科,广东广州市 510515 ;
    2.广东省人民医院,广东省医学科学院胸外科,广东广州市 510515
王龙平(1988-),男,汉族,山西孝义市人,硕士研究生,主管治疗师,主要研究方向:心胸外科围手术期快速康复。

网络出版日期: 2019-10-30

Advance in Perioperative Physical Therapy for Esophageal Cancer (review)

  • WANG Long-ping ,
  • ZENG Bin ,
  • BAI Wen-fang ,
  • DEGN Cheng ,
  • WU Ying-hong ,
  • QIAO Gui-bin
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  • 1.Department of Rehabilitation Medicine,Guangzhou, Guangdong 510515, China;
    2. Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academyof Medical Sciences, Guangzhou, Guangdong 510515, China

Online published: 2019-10-30

摘要

食管癌是我国最常见的消化道恶性肿瘤,目前手术切除仍是治愈食管癌的主要方法。随着加速康复外科理念的提出和实施,围手术期的物理治疗越来越受到重视。本文探讨食管癌患者术前心肺功能评估的必要性,术前的呼吸训练和有氧运动对优化患者体能和减少术后并发症的作用,以及术后早期物理治疗的内容。食管癌患者术前心肺功能与预后关系微弱,可能与食管癌手术的复杂性和术后并发症的高发性有关。术前的吸气肌训练一定程度上能够提高患者的肺功能,但目前还缺乏大样本量的研究;术前的有氧运动能够提高患者的体能储备,应受到重视。食管癌术后早期的物理治疗内容包括疼痛管理、胸部的物理治疗和早期活动,早期活动的运动处方如强度、时间等还有待进一步研究。

本文引用格式

王龙平 , 曾斌 , 白文芳 , 邓澄 , 吴映红 , 乔贵宾 . 食管癌围手术期的物理治疗进展[J]. 中国康复理论与实践, 2019 , 25(10) : 1168 -1171 . DOI: 10.3969/j.issn.1006-9771.2019.10.009

Abstract

Esophageal cancer is the most common malignant tumor of the digestive tract in China. At present, surgical resection is the main method to cure esophageal cancer. With the population and implementation of the enhanced recovery after surgery, perioperative physical therapy plays a more and more important role. This review discussed the necessity of preoperative cardiopulmonary function assessment in patients with esophageal cancer, the effects of preoperative respiratory training and aerobic exercise on optimizing physical fitness and reducing postoperative complications, and the content of early postoperative physical therapy. Preoperative cardiopulmonary function of esophageal cancer patients is not strongly related with the outcome, which may be related to the complexity of esophageal cancer surgery and the high incidence of postoperative complications. Preoperative inspiratory muscle exercise can improve the pulmonary function of patients to some extent, but still lack of large sample size research. Preoperative aerobic exercise for esophageal cancer can improve the patient's physical reserve and should be valued. Postoperative physiotherapy priorities includes pain management, chest physical therapy and early mobilization. Exercise prescriptions such as intensity and time for early mobilization are yet to be further studied.

参考文献

1 BrayF, FerlayJ, SoerjomataramI, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2018, 68(6): 394-424.
2 GillinovA M, HeitmillerR F. Strategies to reduce pulmonary complications after transhiatal esophagectomy [J]. Dis Esophagus, 2017, 11(1): 43-47.
3 LuketichJ D, PennathurA, AwaisO, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients [J]. Ann Surg, 2012, 256(1): 95-103.
4 O'NeillL, GannonJ, GuinanE, et al. Multidisciplinary rehabilitation across the esophageal cancer journey [J]. J Thorac Dis, 2017, 9(12): E1140-E1142.
5 GuinanE M, DowdsJ, DonohoeC, et al. The physiotherapist and the esophageal cancer patient: from prehabilitation to rehabilitation [J]. Dis Esophagus, 2017, 30(1): 1-12.
6 FergusonM K, CelauroA D, PrachandV. Prediction of major pulmonary complications after esophagectomy [J]. Ann Thorac Surg, 2011, 91(5): 1494-1500; discussion 1500-1501.
7 ForshawM J, StraussD C, DaviesA R, et al. Is cardiopulmonary exercise testing a useful test before esophagectomy [J]. Ann Thorac Surg, 2008, 85(1): 294-299.
8 van EgmondM A, van der SchaafM, HagensE R C, et al. Muscle strength is associated with muscle mass in patients with esophageal cancer awaiting surgery [J]. J Geriatr Phys Ther, 2018. [Epub ahead of print]
9 MurrayP, WhitingP, HutchinsonS P, et al. Preoperative shuttle walking testing and outcome after oesophagogastrectomy [J]. Br J Anaesth, 2007, 99(6): 809-811.
10 MoranJ, WilsonF, GuinanE, et al. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review [J]. Br J Anaesth, 2016, 116(2): 177-191.
11 BrunelliA, KimA W, BergerK I, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines [J].Chest, 2013, 143(5 Suppl)e166S-e190S.
12 van EgmondM A, van der SchaafM, KlinkenbijlJ H, et al. Preoperative functional status is not associated with postoperative surgical complications in low risk patients undergoing esophagectomy [J]. Dis Esophagus, 2017, 30(1): 1-7.
13 GuinanE M, FordeC, O'NeillL, et al. Effect of preoperative inspiratory muscle training on physical functioning following esophagectomy [J]. Dis Esophagus, 2019, 32(2). doi: 10.1093/dote/doy091.
14 InoueJ, OnoR, MakiuraD, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer [J]. Dis Esophagus, 2013, 26(1): 68-74.
15 ValkenetK, TrappenburgJ C A, RuurdaJ P, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer [J]. Br J Surg, 2018, 105(5): 502-511.
16 van AdrichemE J, MeulenbroekR L, PlukkerJ T, et al. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study [J]. Ann Surg Oncol, 2014, 21(7): 2353-2360.
17 PouwelsS, HagemanD, GommansL N, et al. Preoperative exercise therapy in surgical care: a scoping review [J]. J Clin Anesth, 2016, 33: 476-490.
18 CoatsV, MaltaisF, SimardS, et al. Feasibility and effectiveness of a home-based exercise training program before lung resection surgery [J]. Can Respir J, 2013, 20(2): e10-6.
19 TimmermanH, de GrootJ F, HulzebosH J, et al. Feasibility and preliminary effectiveness of preoperative therapeutic exercise in patients with cancer: a pragmatic study [J]. Physiother Theory Pract, 2011, 27(2): 117-124.
20 FeeneyC, ReynoldsJ V, HusseyJ. Preoperative physical activity levels and postoperative pulmonary complications post-esophagectomy [J]. Dis Esophagus, 2011, 24(7): 489-494.
21 PfirrmannD, TugS, BrosteanuO, et al. Internet-based perioperative exercise program in patients with Barrett’s carcinoma scheduled for esophagectomy [iPEP - study] a prospective randomized controlled trial [J]. BMC Cancer, 2017, 17(1): 413.
22 GockelI, NiebischS, AhlbrandC J, et al. Risk and complication management in esophageal cancer surgery: a review of the literature [J]. Thorac Cardiovasc Surg, 2016, 64(7): 596-605.
23 FordS J, AdamsD, DudnikovS, et al. The implementation and effectiveness of an enhanced recovery programme after oesophago-gastrectomy: a prospective cohort study [J]. Int J Surg, 2014, 12(4): 320-324.
24 InoueT, ItoS, AndoM, et al. Changes in exercise capacity, muscle strength, and health-related quality of life in esophageal cancer patients undergoing esophagectomy [J]. BMC Sports Sci Med Rehabil, 2016, 8: 34.
25 EneK W, NordbergG, BerghI, et al. Postoperative pain management: the influence of surgical ward nurses [J]. J Clin Nurs, 2008, 17(15): 2042-2050.
26 NakatsuchiT, OtaniM, OsugiH, et al. The necessity of chest physical therapy for thoracoscopic oesophagectomy [J]. J Int Med Res, 2005, 33(4): 434-441.
27 NakamuraM, IwahashiM, NakamoriM, et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer [J]. Langenbecks Arch Surg, 2008, 393(2): 127-133.
28 LunardiA C, CecconelloI, CarvalhoC R. Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy [J]. Rev Bras Fisioter, 2011, 15(2): 160-165.
29 Torres-CastroR, MongeG, VeraR, et al. Therapeutic strategies to increase the effectiveness of cough [J]. Rev Med Chil, 2014, 142(2): 238-245.
30 刘晓峰. 快速康复外科在食管癌外科手术中的应用[J]. 中西医结合心血管病电子杂志, 2017, 5(34): 23.
31 BlomR L, van HeijlM, BemelmanW A, et al. Initial experiences of an enhanced recovery protocol in esophageal surgery [J]. World J Surg, 2013, 37(10): 2372-2378.
32 HanadaM, KanetakaK, HidakaS, et al. Effect of early mobilization on postoperative pulmonary complications in patients undergoing video?assisted thoracoscopic surgery on the esophagus [J]. Esophagus, 2018, 15(2): 69-74.
33 FindlayJ M, GilliesR S, MilloJ, et al. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines [J]. Ann Surg, 2014, 259(3): 413-431.
34 BhattN R, SheridanG, ConnollyM, et al. Postoperative exercise training is associated with reduced respiratory infection rates and early discharge: a case-control study [J]. Surgeon, 2017, 15(3): 139-146.
35 刘晶晶,鲁嘉驹,师将,等. 快速康复外科在食管癌手术患者中应用效果的系统评价与Meta分析[J]. 中国胸心血管外科临床杂志, 2018, 25(7): 596-603.
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