Clinical Application of Vagus Nerve Preservation in Minimally Invasive Surgery for Early Lung Cancer
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 120
- 试验地点
- 1
- 主要终点
- Atelectasis
研究概览
简要总结
Through prospective, randomized and controlled clinical study, patients with early lung cancer who do not need lymph node dissection according to routine diagnosis and treatment were selected. The feasibility and safety of preserving vagal pulmonary branch intact during minimally invasive surgery were compared with traditional minimally invasive surgery, and the feasibility and safety of preserving vagal pulmonary branch intact during minimally invasive surgery were clarified. The effect of preserving pulmonary branches of vagus nerve in minimally invasive surgery of early lung cancer on preventing or reducing pulmonary complications after operation was evaluated by main observation indexes (incidence of pulmonary complications) and secondary evaluation indexes. It will provide a safer, simpler and more effective new technology for patients with early lung cancer undergoing minimally invasive surgery, and provide a basis for the popularization of this new technology.
详细描述
According to the suggestion of statistical experts and the minimum sample size, 120 IA1-2 patients who are going to undergo thoracoscopic lung surgery were selected according to the criteria of admission and exclusion. The risk and benefit were informed and the informed consent of the subjects was signed. The patients were numbered and randomly divided into two groups: group A with vagus nerve preservation during minimally invasive surgery and group B with traditional minimally invasive surgery for early lung cancer. The incidence of pulmonary complications within 5 weeks after operation (see the evaluation criteria for details), operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative mortality, incidence of cardiovascular complications, rate of re-tracheal intubation, rate of re-admission to ICU, duration of stay in ICU, hospitalization costs were observed. Statistical analysis and evaluation of the safety of preserving pulmonary branches of vagus nerve in minimally invasive surgery and the effectiveness of preventing or reducing pulmonary complications after minimally invasive surgery.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •(1) 18-70 years of age, regardless of gender;
- •(2) From May 2019 to December 2021, patients with lung cancer who underwent thoracoscopic pneumonectomy (wedge-shaped, segment and lobe) were admitted to our hospital. Postoperative pathological diagnosis was non-small cell lung cancer. Preoperative pathological staging was T1a-bN0M0 and IA1-2 (pathological staging refers to UICC 8th Edition TNM staging standard for lung cancer).
- •(3) In addition to routine examinations, all patients underwent enhanced chest CT, cranial CT/MRI, abdominal B-mode ultrasound, whole body bone isotope scan or PET-CT to exclude distant metastasis.
- •(4) Subjects clearly understand the purpose of the study, are willing and able to comply with the requirements to complete the study, and sign the informed consent.
排除标准
- •(1) Patients with other infectious diseases (inflammation, tuberculosis, etc.) in the thoracic cavity;
- •(2) Patients are unwilling to accept the new technique of preserving pulmonary branch of vagus nerve during operation;
- •(3) Clinical unstable patients with severe cardiovascular, renal and respiratory system;
- •(4) Participated in other clinical trials within 30 days;
- •(5) Other reasons why researchers think it is inappropriate to participate in the experiment.
研究组 & 干预措施
Preservation of pulmonary vagus nerve
Preservation of pulmonary branches of vagus nerve in minimally invasive surgery for lung cancer
干预措施: In minimally invasive surgery，Vagus nerve preservation (Other)
No pulmonary vagus nerve preservation
In minimally invasive surgery for lung cancer, the pulmonary branches of vagus nerve were severed
干预措施: In minimally invasive surgery，Vagus nerve is not preserved (Other)
结局指标
主要结局
Atelectasis
时间窗: From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.
(1) Imaging findings suggest atelectasis or consolidation of the lungs; (2) signs of dyspnea; (3) decreased oxygen saturation to below 90%.
Postoperative respiratory failure or ARDS or requiring tracheal intubation
时间窗: From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.
Tracheal intubation; Ventilator; ICU
hydrothorax
时间窗: From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.
Re-catheterization was needed; dyspnea symptoms; and drainage time was longer than 15 days.
cough after pulmonary resection
时间窗: From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.
(1) dry cough lasting no less than 2 weeks after pneumonectomy; (2) no obvious abnormalities in chest X-ray; (3) excluding drug factors such as postnasal drip syndrome, bronchial asthma and ACEI
pulmonary infection
时间窗: From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.
Postoperative pneumonia should be considered if there are three or more of the following indicators: 1. Fever occurred 72 hours after operation, and the body temperature increased again within T \> 38 C or 72 hours. 2. Leukocyte count increased (\>12-15\*109/L) or increased again after the leucocyte count returned to normal value, exceeding 10\*109/L; 3. Chest imaging showed consolidation of lung tissue or increasing patchy shadow; 4. cough up purulent sputum or sputum culture positive; If it contains 4, only one of the other items can be considered as a respiratory consultation to determine pulmonary infection, and need to replace antibiotics or prolong the use of antibiotics.
次要结局
- Re-admission ICU rate;(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Intraoperative bleeding volume;(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Postoperative drainage volume;(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Time of stay in ICU;(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Hospitalization days(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Hospitalization expenses(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Operation time;(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Postoperative mortality(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
- Postoperative cardiovascular complications(From the date of randomized grouping to 5 weeks after operation, the evaluation time was as long as 5 weeks.)
研究者
Yongxin Zhou
Director
Shanghai Tongji Hospital, Tongji University School of Medicine