(A) Applicable objects.
The first diagnosis of esophageal cancer is esophageal cancer resection and digestive tract reconstruction.
(B) Diagnostic basis.
1. Clinical symptoms: choking and foreign body sensation; progressive dysphagia; gradual wasting, dehydration and weakness.
2. Auxiliary examination: upper gastrointestinal tract imaging, endoscopy, cervicothoracic and abdominal CT or chest CT and ultrasound of neck and abdomen.
(3) Clear pathological diagnosis (histopathology, cytopathology).
(C) Selection of treatment plan.
To perform esophageal cancer resection and digestive tract reconstruction.
1.Trans-left thoracic surgery, esophageal cancer resection + intrathoracic or cervical esophagogastric anastomosis and lymph node dissection in the chest and abdomen.
2.Through right thoracic surgery, esophageal cancer resection + intrathoracic or cervical esophagogastric anastomosis, lymph node dissection in both thoracic and abdominal fields.
3.Transluminal surgery, esophageal cancer resection + esophagogastric neck anastomosis.
(iv) Standard hospitalization days ≤ 28 days.
(E) Entry pathway criteria.
1.The first diagnosis must be in accordance with ICD-10: C15/D00, 1 esophageal cancer disease code.
2.Meet the indications for surgery and no contraindication to surgery.
3.When the patient is combined with other diseases, but does not need special treatment during hospitalization and does not affect the implementation of the clinical pathway process of the first diagnosis, he/she can enter the pathway.
(F) Preoperative preparation ≤ 7 days.
1.Required examination items.
(1) Routine blood, routine urine + microscopy, routine stool + occult blood.
(2) Coagulation function, blood group, liver function, kidney function, electrolytes, infectious disease screening (hepatitis B, C, AIDS, syphilis, etc.), blood gas analysis, etc.
(3) pulmonary function, electrocardiogram, front and side chest radiograph, upper gastrointestinal tract imaging, endoscopy + tissue biopsy, neck ultrasound or CT, chest CT (plain + enhanced scan), abdominal ultrasound or CT (plain + enhanced scan).
2. Depending on the patient’s condition, the following options are available.
(1) Esophageal endoscopic ultrasound.
(2) Echocardiography, 24-hour ambulatory electrocardiography and other cardiovascular and cerebrovascular disease screening programs, tumor marker testing.
(3) whole-body bone imaging, MRI of relevant areas.
(4) Bronchoscopy for esophageal cancer in the upper thoracic segment and the middle thoracic segment adjacent to the main bronchus.
3. Nutritional status assessment. Perform nutritional assessment according to the inpatient nutritional risk screening NRS-2002 assessment criteria, and provide perioperative nutritional support for malnourished patients as appropriate.
(G) The day of surgery is ≤ 8 days after admission.
1.Anesthesia mode: general anesthesia.
2.Surgical consumables: Depending on the patient’s condition, anastomosis and closure devices may be used.
3.Intraoperative medication: antibacterial drugs, etc.
4.Blood transfusion: depending on the intraoperative condition.
(H) Postoperative hospital recovery ≤ 20 days.
1.Checkup items that must be reviewed: chest X-ray, blood routine, blood biochemistry, electrolytes, blood gas analysis, etc.
2.Postoperative medication.
(1) Antibacterial drug use: Preventive and therapeutic antibacterial drug application in accordance with the “Guidelines for Clinical Application of Antibacterial Drugs” (Health Medical Development [2004] No. 285).
(2) Select acid-suppressing, phlegm-suppressing, analgesic, antispasmodic, antiairway inflammatory and anticoagulant drugs according to the patient’s condition.
(3) Nutritional support: Conduct nutritional assessment according to the inpatient nutritional risk screening NRS-2002 assessment criteria, and focus on parenteral and parenteral nutritional support in the perioperative period.
(ix) Discharge criteria.
1.The patient is in good general condition, with normal body temperature, chest X-ray and blood picture suggesting no signs of infection.
2, can enter the liquid food.
3, good healing of the incision, or poorly healed incision that can be treated in the outpatient clinic.
4.No complications related to this procedure that require hospitalization.
(J) Variation and cause analysis.
1.There are combined diseases that affect the surgery and require relevant diagnosis and treatment.
2.Perioperative complications, which may cause prolonged hospitalization days or costs exceeding the reference cost standard.
3.The reasons for variation recognized by the senior title physician.
4.Patient and other reasons, etc.