您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (11): 44-53.doi: 10.6040/j.issn.1671-7554.0.2022.0960

• 胸外科肺癌、食管癌微创诊治和加速康复专题 • 上一篇    下一篇

解剖性部分肺叶切除术及围术期加速康复外科的临床综合应用

彭岳1,2,刘雷1,3,李原1,别凤龙1,周博伦1,李润泽1,冀瑛2,白广宇1,谭锋维1,高禹舜1,牟巨伟1,薛奇1,邱斌1,*(),高树庚1,*()   

  1. 1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院胸外科, 北京 100021
    2. 首都医科大学附属北京朝阳医院 北京市呼吸疫病研究所胸外科, 北京 100020
    3. 河北省承德市中心医院/承德医学院第二临床学院, 河北 承德 067000
  • 收稿日期:2022-08-11 出版日期:2022-11-01 发布日期:2022-11-04
  • 通讯作者: 邱斌,高树庚 E-mail:drqiubin@aliyun.com;gaoshugeng@cicams.ac.cn
  • 基金资助:
    国家重点研发计划(2021YFC2500900);国家自然科学基金(82273129);中国医学科学院医学与健康科技创新工程(2021-I2M-1-015);中央保健专项资金(2022ZD17);院所科研课题(LC2019L01)

Comprehensive application of anatomical partial lobectomy and enhanced recovery after surgery

Yue PENG1,2,Lei LIU1,3,Yuan LI1,Fenglong BIE1,Bolun ZHOU1,Runze LI1,Ying JI2,Guangyu BAI1,Fengwei TAN1,Yushun GAO1,Juwei MU1,Qi XUE1,Bin QIU1,*(),Shugeng GAO1,*()   

  1. 1. Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    2. Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
    3. Chengde Central Hospital, The Second Clinical College of Chengde Medical University, Chengde 067000, Hebei, China
  • Received:2022-08-11 Online:2022-11-01 Published:2022-11-04
  • Contact: Bin QIU,Shugeng GAO E-mail:drqiubin@aliyun.com;gaoshugeng@cicams.ac.cn

RichHTML

0

PDF (PC)

18

摘要：

目的: 总结分析解剖性部分肺叶切除术(APL)以及围术期加速康复外科(ERAS)的统筹应用经验，以期为肺癌外科微创治疗的综合管理提供临床参考与理论支持。方法: 回顾性分析中国医学科学院肿瘤医院胸外科肺癌数据库2013年11月1日至2021年10月31日接受APL手术的6 449例患者的临床病理学资料以及围手术期数据，包括性别、年龄、吸烟史、手术方式、病理、术后住院日等指标。以2014—2018年作为经验积累阶段，2019—2021年作为技术成熟阶段。比较两阶段在手术量、良性结节占比、术后平均住院日、术后住院日超7 d的差异。结果: 纳入患者6 449例，其中男2 094例，女4 355例。分期完成两侧肺部手术88台，同期完成双侧手术8台，共完成APL手术6 493台。技术成熟阶段较经验积累阶段的年度月均手术量增加、良性结节占比减少、术后平均住院日缩短、术后住院日超7 d占比减少(P＜0.05)。通过结合ERAS理念优化本中心APL围术期管理细节，成功使得患者术后平均住院日从6.98 d显著降至3.96 d。术后住院日超7 d患者占比由23.80%降至2.87%，多因素Logistic回归分析结果显示性别、年龄、手术术式、手术阶段是APL术后住院日超7 d的独立危险因素。结论: ERAS能够优化APL围术期管理流程，加速患者术后康复。而APL手术可以在保证肿瘤学原则的前提下，为患者保留更多的健康肺组织，实现手术切除范围、手术创伤的最小化，为ERAS理念能够更好地在肺癌根治手术中应用推广提供了必要的临床实践基础。

关键词: 加速康复, 解剖性部分肺叶切除术, 胸腔镜, 肺癌, 肺结节

Abstract:

Objective: To summarize the application of anatomical partial lobectomy (APL) and enhanced recovery after surgery (ERAS) in order to provide clinical reference and theoretical support for the comprehensive management of minimally invasive surgical treatment of lung cancer. Methods: The clinicopathological and perioperative data of 6, 449 patients who underwent APL during Nov. 1, 2013 and Oct. 31, 2021 were retrospectively collected, including gender, age, smoking history, surgical method, pathology, postoperative hospital stay and other indicators. The period from 2014 to 2018 was regarded as the experience accumulation stage, and the period from 2019 to 2021 the technology maturity stage. The number of surgery, percentage of benign nodules, average postoperative hospital stay, and percentage of postoperative hospital stay over 7 days were compared between the two stages. Results: Of the 6, 449 patients, 2, 094 were males and 4, 355 were females. Among them, 88 bilateral lung surgeries were performed in stages, and 8 bilateral surgeries were performed simultaneously, and altogether 6, 493 APL surgeries were performed. Compared with the experience accumulation stage, in the technology maturity stage, the annual average monthly number of operations increased, the percentage of benign nodules decreased, the average postoperative hospital stay shortened, and the percentage of postoperative hospital stay longer than 7 days decreased (P < 0.05). With the application of ERAS from 2014 to 2021, the average annual postoperative hospital stay for APL gradually decreased from 6.98 days to 3.96 days. The percentage of patients with postoperative hospital stay exceeding 7 days decreased from 23.80% to 2.87%. The results of multivariate Logistic regression analysis showed that gender, age, surgical procedure, and surgical stage were independent risk factors for postoperative hospital stay more than 7 days after APL. Conclusion: ERAS can optimize the perioperative management of APL and accelerate postoperative recovery of patients. APL can be performed on the premise of oncology principles, preserve more healthy lung tissue, minimize the scope of surgical resection and surgical trauma, so that the concept of ERAS can be better applied and promoted in radical surgery for lung cancer.

Key words: Enhanced recovery after surgery, Anatomical partial lobectomy, Thoracoscopy, Lung cancer, Pulmonary nodules

中图分类号: 

  • R734.2

图1

结节位于右肺上叶前段(RS3) A：横断位(肺窗)；B：横断位(纵隔窗)；C：矢状位(肺窗)；D：冠状位(肺窗)。"

图2

术前右上肺三维重建规划手术区域 A：右上肺支气管、血管三维重建图像；B：等比例3D打印模型；C：RS3结节安全切缘球(黄)；D：拟切除范围规划(RS3扩大切除)。"

图3

解剖性部分肺叶切除术(RS3扩大切除术) A：清扫10区淋巴结送冰冻病理；B：结扎V3a和V3b+c静脉；C：离断A3动脉；D：离断V1b静脉，暴露B3支气管；E：利用膨胀萎陷法显露切割平面；F：电刀标记切割平面；G：电刀劈开切割平面；H：切割闭合器离断肺组织；I：移除目标肺组织。"

图4

APL术后第1天(POD1)和术后第3天(POD3)胸部正位片"

表1

6 493台次解剖性部分肺叶切除术患者的临床病理学特征"

项目 例数(%)
性别
  男 2 094(32.25)
  女 4 399(67.75)
年龄(岁)
  ≤60 4 322(66.56)
  ＞60 2 171(33.44)
吸烟史
  有 1 170(18.02)
  无 5 323(81.98)
病理类型
  良性 458(7.05)
  转移瘤 110(1.69)
  浸润前病变 1 016(15.65)
  腺癌 4 800(73.93)
  鳞状细胞癌 62(0.95)
  小细胞肺癌 10(0.15)
  其他 37(0.57)
手术方式
  APL±楔形等 6 279(96.70)
  肺叶+APL 214(3.30)
手术阶段
  2014~2018年 1 854(28.55)
  2019~2021年 4 639(71.45)

图5

APL年手术台次趋势(A)及肺良性结节占比趋势(B)"

图6

解剖性部分肺叶切除术后住院日 A：术后年平均住院日变化趋势；B：术后住院日超7 d占比趋势。"

表2

APL术后住院日超7d的单因素分析"

项目 术后住院日[ n(%)] χ2 P
≤7 d ＞7 d
性别
  男 1 972(94.17) 122(5.83) 18.418 ＜0.001
  女 4 244(96.48) 155(3.52)
年龄(岁)
  ≤60 4 171(96.51) 151(3.49) 18.881 ＜0.001
  ＞60 2 045(94.20) 126(5.80)
吸烟史
  有 1 101(94.10) 69(5.90) 9.299 0.002
  无 5 115(96.09) 208(3.91)
手术术式
  APL±楔形等 6 018(95.84) 261(4.16) 5.585 0.018
  肺叶+APL 198(92.52) 16(7.48)
手术阶段
  2014~2018年 1 686(90.94) 168(9.06) 146.107 ＜0.001
  2019~2021年 4 530(97.65) 109(2.35)

表3

APL术后住院日超7 d的多因素Logistic回归分析"

项目 B 标准误 Wald P OR 95%CI
性别 0.540 0.155 12.083 0.001 1.715 1.265~2.325
年龄 0.455 0.127 12.815 0.000 1.576 1.228~2.021
吸烟史 -0.123 0.181 0.462 0.497 0.884 0.621~1.260
手术术式 0.626 0.275 5.175 0.023 1.871 1.091~3.209
手术阶段 -1.419 0.127 124.716 0.000 0.242 0.189~0.310
1 Kehlet H , Mogensen T . Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme[J]. Br J Surg, 1999, 86 (2): 227- 230.
2 Miller TE , Thacker JK , White WD , et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol[J]. Anesth Analg, 2014, 118 (5): 1052- 1061.
doi: 10.1213/ANE.0000000000000206
3 Kehlet H . Fast-track colorectal surgery[J]. Lancet, 2008, 371 (9615): 791- 793.
doi: 10.1016/S0140-6736(08)60357-8
4 Ljungqvist O , Scott M , Fearon KC . Enhanced recovery after surgery: a review[J]. JAMA Surg, 2017, 152 (3): 292- 298.
doi: 10.1001/jamasurg.2016.4952
5 Duan L , Jiang G , Yang Y . One hundred and fifty-six cases of anatomical pulmonary segmentectomy by uniportal video-assisted thoracic surgery: a 2-year learning experience[J]. Eur J Cardiothorac Surg, 2018, 54 (4): 677- 682.
doi: 10.1093/ejcts/ezy142
6 Hernandez-Arenas LA , Purmessur RD , Gonzalez-Rivas D . Uniportal video-assisted thoracoscopic segmentectomy[J]. J Thorac Dis, 2018, 10 (suppl 10): S1205- S1214.
7 Bertolaccini L , Batirel H , Brunelli A , et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)[J]. Eur J Cardiothorac Surg, 2019, 56 (2): 224- 229.
doi: 10.1093/ejcts/ezz133
8 Han D , Cao Y , Wu H , et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: a consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS)[J]. Transl Lung Cancer Res, 2020, 9 (4): 971- 987.
doi: 10.21037/tlcr-20-576
9 邱斌, 冀瑛, 张帆, 等. 解剖性部分肺叶切除术治疗3 336例肺结节患者的疗效[J]. 中华肿瘤杂志, 2021, 43 (1): 137- 142.
doi: 10.3760/cma.j.cn112152-20201014-00900
QIU Bin , JI Ying , ZHANG Fan , et al. Anatomical partial lobectomy for the treatment of 3, 336 cases of patients with lung nodule[J]. Chinese Journal of Oncology, 2021, 43 (1): 137- 142.
doi: 10.3760/cma.j.cn112152-20201014-00900
10 Qiu B , Ji Y , Zhang F , et al. Outcomes and experience of anatomical partial lobectomy[J]. J Thorac Cardiovasc Surg, 2022, 164 (3): 637- 647.
doi: 10.1016/j.jtcvs.2021.11.044
11 邱斌, 冀瑛, 白广宇, 等. 解剖性部分肺叶切除术治疗早期肺癌: 实践与发展[J]. 中华胸部外科电子杂志, 2020, 7 (4): 240- 246.
doi: 10.3877/cma.j.issn.2095-8773.2020.04.07
QIU Bin , JI Ying , BAI Guangyu , et al. Clinical practice and development on anatomic partial lobectomy for early-stage lung cancer[J]. Chinese Journal of Thoracic Surgery (Electronic Edition), 2020, 7 (4): 240- 246.
doi: 10.3877/cma.j.issn.2095-8773.2020.04.07
12 Qiu B , Ji Y , He H , et al. Three-dimensional reconstruction/personalized three-dimensional printed model for thoracoscopic anatomical partial-lobectomy in stage I lung cancer: a retrospective study[J]. Transl Lung Cancer Res, 2020, 9 (4): 1235- 1246.
doi: 10.21037/tlcr-20-571
13 Oizumi H , Endoh M , Takeda S , et al. Anatomical lung segmentectomy simulated by computed tomographic angiography[J]. Ann Thorac Surg, 2010, 90 (4): 1382- 1383.
doi: 10.1016/j.athoracsur.2009.11.062
14 Oizumi H , Kanauchi N , Kato H , et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases[J]. J Thorac Cardiovasc Surg, 2011, 141 (3): 678- 682.
doi: 10.1016/j.jtcvs.2010.08.027
15 车国卫. 加速康复外科: 临床应用加减之间?[J]. 中国肺癌杂志, 2019, 22 (11): 681- 686.
doi: 10.3779/j.issn.1009-3419.2019.11.01
CHE Guowei . Proper selection of enhanced recovery after surgery programs between the medical service and medical intervence-is it time to do?[J]. Chinese Journal of Lung Cancer, 2019, 22 (11): 681- 686.
doi: 10.3779/j.issn.1009-3419.2019.11.01
16 支修益, 刘伦旭, 中国胸外科围手术期气道管理指南版编写委员会. 中国胸外科围手术期气道管理指南(2020版)[J]. 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
ZHI Xiuyi, LIU Lunxu. Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition)[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 251-262.
17 Mills E , Eyawo O , Lockhart I , et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis[J]. Am J Med, 2011, 124 (2): 144- 154.
doi: 10.1016/j.amjmed.2010.09.013
18 Berger M , Schenning KJ , Brown CH , et al. Best practices for postoperative brain health: recommendations from the fifth international perioperative neurotoxicity working group[J]. Anesth Analg, 2018, 127 (6): 1406- 1413.
doi: 10.1213/ANE.0000000000003841
19 Tiwary N , Treggiari MM , Yanez ND , et al. Agreement between the mini-cog in the preoperative clinic and on the day of surgery and association with postanesthesia care unit delirium: a cohort study of cognitive screening in older adults[J]. Anesth Analg, 2021, 132 (4): 1112- 1119.
doi: 10.1213/ANE.0000000000005197
20 刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022)[J]. 协和医学杂志, 2022, 13 (3): 387- 401.
LIU Zijia , ZHANG Lu , LIU Hongsheng , et al. Expert consensus on prehabilitation management for enhanced recovery in patients undergoing thoracic surgery (2022)[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13 (3): 387- 401.
21 Lumb AB . Pre-operative respiratory optimisation: an expert review[J]. Anaesthesia, 2019, 74 (Suppl 1): 43- 48.
22 Lai YT , Su JH , Qiu PY , et al. Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial[J]. Interact CardioVasc Thorac Surg, 2017, 25 (3): 476- 483.
doi: 10.1093/icvts/ivx141
23 Licker M , Karenovics W , Diaper J , et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial[J]. J Thorac Oncol, 2017, 12 (2): 323- 333.
doi: 10.1016/j.jtho.2016.09.125
24 Baimas-George M , Watson M , Elhage S , et al. Prehabilitation in frail surgical patients: a systematic review[J]. World J Surg, 2020, 44 (11): 3668- 3678.
doi: 10.1007/s00268-020-05658-0
25 Gao K , Yu PM , Su JH , et al. Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: a study for 342 cases[J]. Thorac Cancer, 2015, 6 (4): 443- 449.
doi: 10.1111/1759-7714.12199
26 Low DE , Allum W , De Manzoni G , et al. Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS?) society recommendations[J]. World J Surg, 2019, 43 (2): 299- 330.
doi: 10.1007/s00268-018-4786-4
27 Zhou D , Deng XF , Liu QX , et al. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis[J]. J Cardiothorac Surg, 2016, 11 (1): 88.
doi: 10.1186/s13019-016-0484-1
28 Kim SS , Khalpey Z , Daugherty SL , et al. Factors in the selection and management of chest tubes after pulmonary lobectomy: results of a national survey of thoracic surgeons[J]. Ann Thorac Surg, 2016, 101 (3): 1082- 1088.
doi: 10.1016/j.athoracsur.2015.09.079
29 Zhang TX , Zhang Y , Liu ZD , et al. The volume threshold of 300 versus 100 ml/day for chest tube removal after pulmonary lobectomy: a meta-analysis[J]. Interact Cardio Vasc Thorac Surg, 2018, 27 (5): 695- 702.
doi: 10.1093/icvts/ivy150
30 张娜, 张欢欢, 李玉善, 等. 加速康复外科理念下肺肿瘤患者术后病房留置尿管危险因素的病例对照研究[J]. 中国胸心血管外科临床杂志, 2021, 28 (7): 821- 825.
ZHANG Na , ZHANG Huanhuan , LI Yushan , et al. Risk factors for postoperative retention of urinary catheters in patients with lung tumors under concept of enhanced recovery after surgery: a case-control study[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28 (7): 821- 825.
31 Brunelli A . Deep vein thrombosis/pulmonary embolism: prophylaxis, diagnosis, and management[J]. Thorac Surg Clin, 2012, 22 (1): 25- 28.
doi: 10.1016/j.thorsurg.2011.08.014
32 姚丽, 郑娥, 杨梅, 等. 基于患者报告结局的胸腔镜肺癌切除术后患者症状调查[J]. 中国胸心血管外科临床杂志, 2022, 1- 6.
doi: 10.7507/1007-4848.202112082
YAO Li , ZHENG E , YANG Mei , et al. A survey of symptoms after thoracoscopic lung cancer resection based on patient reported outcomes[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 1- 6.
doi: 10.7507/1007-4848.202112082
33 Dai W , Feng W , Zhang Y , et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: a multicenter randomized controlled trial[J]. J Clin Oncol, 2022, 40 (9): 988- 996.
doi: 10.1200/JCO.21.01344
34 沈诚, 李珏, 李鹏飞, 等. 加速康复外科评价指标: 病人报告结局在胸外科的临床应用现状与进展[J]. 中国肺癌杂志, 2019, 22 (3): 161- 166.
SHEN Cheng , LI Jue , LI Pengfei , et al. Evaluation index of enhanced recovery after surgery: status and progress of patient report outcomes in thoracic surgery[J]. Chinese journal of lung cancer, 2019, 22 (3): 161- 166.
35 Fagundes CP , Shi Q , Vaporciyan AA , et al. Symptom recovery after thoracic surgery: measuring patient-reported outcomes with the MD Anderson Symptom Inventory[J]. J Thorac Cardiovasc Surg, 2015, 150 (3): 613- 619.
doi: 10.1016/j.jtcvs.2015.05.057
36 车国卫. 加速康复外科: 肺癌手术日间化现状与策略[J]. 中国肺癌杂志, 2020, 23 (1): 1- 4.
CHE Guowei . Current situation and strategy of day surgery in patients with lung cancer by enhanced recovery after surgery[J]. Chinese journal of lung cancer, 2020, 23 (1): 1- 4.
[1] 梁晨,姚丽娟,吕龙飞,唐泽,秦达,崔有斌,余孝淇. 三维重建联合CT引导下穿刺定位在微创治疗肺磨玻璃结节中的应用[J]. 山东大学学报 (医学版), 2026, 64(5): 74-82.
[2] 黄佩文, 王旭东. 治疗非小细胞肺癌新药:靶向c-Met蛋白的抗体药物偶联物Telisotuzumab Vedotin[J]. 山东大学学报 (医学版), 2026, 64(3): 124-130.
[3] 赵汉卿,周新睿,李子建,唐兴. 循环肿瘤细胞联合血清学检测在非小细胞肺癌中的应用[J]. 山东大学学报 (医学版), 2025, 63(5): 79-85.
[4] 胡冰涛,张文灿,王崇怡,林翔宇,王凯斌,冯运泽,刘郴,徐万龙,李乐,司海朋. 基于加速康复外科理念的单孔分体内镜微创技术治疗腰椎管狭窄症的临床效果分析[J]. 山东大学学报 (医学版), 2025, 63(3): 1-7.
[5] 马志虎,于晓凤,孙玉亮,王刚,裴艳涛,陈斌,史安浩,乔丽,朱磊. 加速康复外科综合治疗在三角纤维软骨复合体损伤患者围术期中的应用[J]. 山东大学学报 (医学版), 2025, 63(3): 28-35.
[6] 徐年兴,魏东,乔俊杰,战炳炎. CD8+、IL-6和PaO2对不可切除ⅢB/C和Ⅳ期非小细胞肺癌免疫治疗触发放射召回性肺炎的预测价值[J]. 山东大学学报 (医学版), 2025, 63(2): 29-35.
[7] 山东省腔镜外科质量控制中心胸腔镜委员会. 山东省VATS/RATS非小细胞肺癌围术期质量控制指标专家共识(2025版)[J]. 山东大学学报 (医学版), 2025, 63(12): 1-5.
[8] 李懿原,马珊,李爱华,龙飞. 超声支气管镜引导下碘-125粒子植入治疗肺癌中央区淋巴结转移[J]. 山东大学学报 (医学版), 2025, 63(12): 26-34.
[9] 刘振昆,吕纪玲,徐伟伟,马力天,张才擎. BALF tNGS检测及培养对NSCLC合并IPFD的诊断价值[J]. 山东大学学报 (医学版), 2025, 63(11): 36-45.
[10] 张荣雨,赵文,李洪欣,杨闯,王健,韩春燕,李际盛. 奥西替尼联合化疗一线治疗EGFR-RAD51融合突变转移性肺腺癌1例[J]. 山东大学学报 (医学版), 2024, 62(5): 116-120.
[11] 白晓亮,孙盼盼,王泓力,龚顺之,孙云起,舒梦,戚晓良. 内科胸腔镜下内脏神经切断术的动物实验[J]. 山东大学学报 (医学版), 2024, 62(4): 9-13.
[12] 司海朋,王崇怡,宫桂青,张文灿,郭英俊,王凯斌,冯运泽,徐万龙,李乐. 加速康复外科在脊柱外科中的应用进展[J]. 山东大学学报 (医学版), 2024, 62(10): 8-17.
[13] 张杨,李晓旭. 加速康复外科理念在骨折治疗中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 18-25.
[14] 冯昌,郭岩,赵杰,赵鑫. 加速康复外科理念下超声引导区域阻滞在骨科手术中的研究进展[J]. 山东大学学报 (医学版), 2024, 62(10): 26-35.
[15] 华裔骨科学会骨科康复专业委员会. 全膝关节置换术后膝关节功能加速康复专家共识[J]. 山东大学学报 (医学版), 2024, 62(10): 48-61.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发