Get well, patient | How should lung cancer patients recover after surgery?

With the continuous increase in the incidence rate, cancer, as the main killer of human health, has become a major public health problem facing our country. The country attaches great importance to cancer prevention and treatment, and lists cancer prevention and treatment as one of the major special actions of Healthy China. Cancer rehabilitation refers to the use of advanced and systematic comprehensive treatment and rehabilitation methods to promote the recovery of patients' body functions, improve their quality of life and self-care ability, and enable them to return to society to the greatest extent possible for the physical and mental dysfunction of cancer patients. As the last link in cancer prevention and treatment, it is also the most easily overlooked link. How to help patients recover correctly, in specific practice, the degree of attention and guidance measures are still insufficient. Most cancer patients have no way to consult their doctors in the first place, and the information on the Internet is often one-sided or even wrong.

Lung cancer recovery advice

Lung cancer has a high incidence and mortality rate, and is one of the most threatening malignant tumors to people's health and life. Although the treatment methods for lung cancer are changing with each passing day, surgery is still one of the most important ways to treat lung cancer. Surgical trauma and postoperative complications may have different degrees of impact on the patient's body. However, taking reasonable nursing measures during the perioperative period is extremely important for the rapid recovery of lung cancer patients and the reduction of complications after surgery.

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1. How to care for the wound after lung cancer surgery?

Correct wound care after surgery for lung cancer patients is particularly important for promoting wound healing and preventing infection. First, pay attention to the wound dressing during daily rounds, such as whether the dressing has fallen off, whether the gauze is dry and clean, whether the wound has abnormal exudation, whether there is any odor, etc., and change the wound dressing regularly. Secondly, observe whether the patient has fever, check whether the wound site is red, swollen, hot, painful, hardened or fluctuating, and observe whether the wound has bleeding or exudate. If there is bleeding or pus, it is recommended to perform debridement and dressing change in time. Thirdly, the time for postoperative wound dressing change is roughly 3 to 4 days for sterile incisions, 2 to 3 days for contaminated incisions, and 1 to 2 days for infected wounds, depending on the type of surgery and doctor's advice. Slight swelling, itching, pain and numbness of the wound within 6 to 8 weeks are normal manifestations after surgery. Avoid strenuous activities and keep the surgical site warm to promote wound healing. Finally, ensure adequate nutrition for the diet to facilitate wound tissue repair.

2. How long do lung cancer patients need to rest after surgery, and what daily activities can they do?

The recuperation time after lung cancer surgery is related to many factors, such as the patient's age, general condition, size of surgical trauma, preoperative complications, early postoperative rehabilitation training, and personal tolerance to pain. The physical fitness and respiratory function of lung cancer patients after discharge are a gradual recovery process, so the daily activities that can be done are mainly determined by the recovery situation, and there are no special restrictions. Generally speaking, patients who can take care of themselves when they are discharged from the hospital will gradually recover their physical strength after resting for 1 to 2 weeks, and general mental work such as office work can be completed. After resting for 1 month, lighter physical work can be completed, such as housework, business trips and flying, etc., which are generally not affected. After resting for 3 months, general physical work can be competent. After resting for half a year, unless there are abnormalities in the reexamination or there are problems with the body itself, there are no special restrictions on work. In general, it is recommended to do some simple daily activities in the early stage, such as walking, dining, chatting, etc., and then gradually add some leisure sports, such as skipping rope, fishing, shuttlecock kicking, dancing, fitness, etc., with the standard that the body does not feel tired and the cardiopulmonary function can withstand it, and the activity venue should choose a place with good air circulation as much as possible.

3. How do lung cancer patients conduct rehabilitation training after surgery?

Rehabilitation training after lung cancer surgery mainly includes two aspects. The first is respiratory function training. After lung cancer surgery, patients may have varying degrees of lung function impairment. Respiratory function training can help restore lung function. In the early postoperative period (in the hospital), abdominal breathing, balloon blowing and other methods can be used to exercise respiratory function. Later, you can take a walk or slow walk. If the body allows, gradually increase the amount of exercise, such as cycling, swimming, running and other aerobic exercises. Training requires perseverance and gradual progress. Each training should be based on feeling a little tired but the body can recover quickly through rest. The second is upper limb function training on the surgical side. Lung cancer surgery may damage the blood vessels, nerves and muscles around the incision, causing shoulder stiffness and muscle atrophy in some patients. Correct and scientific upper limb function training on the affected side can help the limb edema subside and the superficial feeling of the skin at the surgical site be restored, the range of motion of the shoulder joint can be restored as soon as possible, and the ability to take care of oneself can be restored to the maximum extent. Generally, upper limb function rehabilitation training can be started after the chest drainage tube is removed after surgery, and family members can assist in completing it. The training movements include lifting, extending, abducting, adducting, internal rotation and external rotation of the shoulder joint, rising, retracting, external movement and rotation of the scapula, and flexion, extension and rotation of the elbow joint. For movements with limited motor ability, each movement can be trained for 3 to 5 minutes each time, 3 to 4 times a day. Lines can be drawn on the wall to mark the position each time, and the position of each exercise should be the same as or exceed the previous one.

4. What should lung cancer patients do if they experience numbness and pain in the chest wall after surgery?

Chronic pain may occur after thoracotomy or laparoscopic surgery for lung cancer, with an incidence of about 5% to 65%. It usually lasts for more than 3 months. 50% of patients still have pain 2 years after surgery, and 30% of patients have pain that can last for 4 to 5 years. Some women and people with anxious or sensitive personalities are more likely to experience it. It manifests as persistent pain symptoms at the incision site even though the surgical incision has healed, or numbness and tightness distributed in a semicircular pattern along the chest incision and the front, as if wrapped in a bandage or pressed by a stone, or persistent dull pain or burning sensation. It may also manifest as abnormal sensitivity of the local skin, with tingling sensation when clothes touch or brush against it, often accompanied by pain in the shoulder on the same side of the surgery. These symptoms may be aggravated by coughing, limb activity, mood swings, and weather changes. The main cause of chronic pain is inflammatory reaction to the incision or nerve damage caused directly by surgery, especially numbness of the chest wall and chronic pain after thoracotomy. Once it occurs, patients must first maintain a positive and optimistic attitude psychologically and face and overcome it bravely. Secondly, after evaluation by the attending physician, the following treatment options can be selected: ① Oral analgesics; ② Sedatives; ③ External patches for pain relief; ④ Acupuncture and local care; ⑤ Surgical treatment. Finally, about 4% of patients experience severe pain, the degree and frequency of which seriously affect their sleep and daily life. Intercostal nerve blockade or even surgical resection of the intercostal nerves can be performed to block the pain transmission of abnormal discharges.

5. What should be done if lung cancer patients develop pleural effusion after surgery?

After lung cancer surgery, a chest drainage tube is routinely left in place to drain the exudate from the wound surface; when the patient's chest drainage fluid is not much or the color is very light, the chest drainage tube will be considered for removal to speed up the patient's postoperative recovery; but for some patients, after the chest drainage tube is removed, there will still be fluid in the chest cavity, that is, pleural effusion, commonly known as pleural effusion. The reasons for the effusion after tube removal include: ① There may be fluid in the chest cavity itself, but it cannot be drained from the drainage tube. For example, the effusion is in the back, and the patient has little activity, causing the effusion in the back to be unable to be drained from the drainage tube in the front; ② Due to malnutrition of the patient leading to hypoproteinemia, it causes transudative pleural effusion; ③ There are also patients with atelectasis. After the chest drainage tube is removed, the lungs cannot fit with the chest wall, forming a residual cavity. The residual cavity is a negative pressure environment, which is bound to form effusion filling. Therefore, patients are often encouraged to cough more after surgery to avoid atelectasis and reduce the occurrence of pleural effusion. If the amount of effusion is not large, no special treatment is usually required and it can be absorbed naturally. If the amount of effusion is large and the patient has fever and other discomforts, thoracentesis can be performed to drain the pleural effusion (that is, re-install the chest drainage tube).

6. What should be done if lung cancer patients develop cough and sputum, sputum retention, atelectasis or lung infection after surgery?

After surgery, lung cancer patients will cough repeatedly within a few months due to tracheal or bronchial mucosal damage, surgical wound repair, local pleural effusion stimulation and other reasons. It is usually a dry cough, which usually does not need to be treated or some cough suppressants are taken orally in severe cases to wait for the body to recover. During the operation, there will be multiple lung collapse and expansion, and the traction of the oval forceps on the healthy lung tissue during the operation will cause fluid exudation, which will infiltrate into the alveolar cavity to form sputum. If it is simply a lot of sputum, it is white foamy sputum or mucous sputum, just try to cough it out; if the sputum is relatively viscous, some expectorants, such as ambroxol tablets or nebulization treatment, can be used to help cough up the sputum. Poor expectoration will cause sputum retention, block the bronchi, and cause the re-expanded lung to become deflated again, leading to atelectasis. In addition, poor expectoration after surgery will also aggravate bacterial reproduction and aggravate lung infection. Therefore, lung infection and atelectasis complement each other. Atelectasis can cause lung infection, and lung infection produces more exudation, further aggravating atelectasis. Therefore, after lung cancer surgery, patients can cough and expectorate more, take deep breaths, blow balloons more often, and pat their backs frequently to help them recover. If patients cough up purulent sputum or have a fever, they should consider the possibility of lung infection and should go to the hospital for treatment in time.

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7. What should be done if lung cancer patients develop hemoptysis and emphysema after surgery?

Lung cancer surgery requires the removal of a lobe or part of the lobe tissue. The remaining lung will expand to fill the cavity of the removed lung, resulting in compensatory pulmonary hyperinflation. This is a normal physiological process and does not require treatment. In addition, bleeding from the wound formed by the removal of lung tissue is coughed out through the bronchi and trachea, and usually improves quickly after the use of hemostatics or the activation of the body's coagulation mechanism. After discharge, the patient may bleed and cough up blood again. At this time, the color of the sputum should be observed first. If it is a dark red old blood clot, it is generally a blood clot accumulated in the lung that is slowly coughed out and can be left untreated. If it is relatively fresh bloody sputum, it may be that the wound surface of the lung section is torn. Secondly, observe the amount of bleeding. If the amount of hemoptysis is small, such as only 2 to 3 mouthfuls of bloody sputum a day, with a total amount of less than 20 mL, you can continue to observe or take Yunnan Baiyao orally for treatment; if the amount of hemoptysis is relatively large, with more than 50 mL of hemoptysis at a time or more than 200 mL of hemoptysis a day, you need to go to the hospital for treatment immediately.

8. What should lung cancer patients do if they suffer from shortness of breath after surgery?

Because lung cancer surgery requires the removal of part of the lung tissue and the incision of the intercostal muscles, coupled with the influence of multiple factors such as surgical trauma and postoperative pneumonia exudation, the patient's lung function will inevitably be reduced after surgery. It is normal for patients to feel short of breath and breathless after walking for a while or going up a floor after surgery. Generally, they will gradually recover to a level close to the preoperative level in about half a year and do not require special treatment. Strengthen nutrition at ordinary times, and do some rehabilitation training that you can bear in the early stage, such as walking and Tai Chi. Use feeling a little tired as the standard, and then gradually increase the activity time and amount step by step. However, if the shortness of breath suddenly worsens, you need to go to the hospital immediately to find out the cause.

9. What should be done if lung cancer patients develop lower limb venous thrombosis after surgery?

In the early postoperative period of lung cancer patients, coagulation function changes may occur for a period of time. The patient's blood is in a hypercoagulable state. In addition, the long bed rest time after surgery can easily cause lower extremity venous thrombosis. Depending on the location and degree of lower extremity venous thrombosis, the symptoms will vary. Superficial venous thrombosis often manifests as pain and redness along the vein, with local cord-like or nodular tenderness areas; deep vein thrombosis often manifests as sudden swelling of one lower limb. Deep vein thrombosis occurring above the knee joint will cause limb pain, obvious swelling, and superficial varicose veins. Severe deep vein thrombosis may cause cyanosis of the skin, local skin temperature decreases, and tissue necrosis. After lower extremity venous thrombosis occurs, you should go to the hospital immediately, rest in bed for more than 2 weeks, and take anticoagulant, thrombolytic or surgical treatment according to the severity. The most important thing is thrombosis prevention. Getting up and moving as soon as possible after surgery can reduce the risk of thrombosis; active leg exercises or leg raising can help prevent deep vein thrombosis in the lower limbs (for patients with severe conditions, difficulty in movement or who need long-term bed rest, it is recommended to use mechanical assist devices for passive leg exercises); patients should drink more water after surgery to avoid dehydration; if the thrombosis assessment is medium to high risk at discharge, you can continue to take oral anticoagulants for a period of time to reduce the risk of lower limb venous thrombosis.

10. What should be done if lung cancer patients develop pulmonary embolism after surgery?

Pulmonary embolism in patients with lung cancer after surgery is mostly caused by the detachment of blood clots in the lower limb veins. Depending on the size of the thrombus and the site of embolism, the symptoms and degree of risk are also different. Mild cases may have no symptoms, and the patient only discovers pulmonary embolism during a follow-up examination; more severe cases may experience chest pain, shortness of breath, and difficulty breathing; severe cases may suffer from respiratory failure, shock, or even death. If the patient suddenly experiences severe chest pain, shortness of breath or difficulty breathing, or even coma after being discharged from the hospital, he or she needs to go to the hospital immediately. Pulmonary embolism is mainly prevented, especially lower limb venous thrombosis. Once lower limb venous thrombosis occurs, go to the hospital as soon as possible to receive standardized and effective treatment.

11. What should be done if a lung cancer patient develops bronchopleural fistula after surgery?

Bronchopleural fistula refers to the formation of an abnormal channel between the bronchus and the pleural cavity. The main reasons for the occurrence of bronchopleural fistula in lung cancer patients after surgery include trauma, infection, and poor tissue healing ability. It is formed because the pus of chronic empyema corrodes the adjacent lung tissue and then penetrates the bronchus, or because the lesions in the lung directly invade the chest cavity or rupture into the pleural cavity to form a fistula, or it is caused by chest puncture or surgical resection of the abscess cavity infection. In the early stage, there are mainly severe chest tightness, shortness of breath, palpitations and other tension pneumothorax manifestations, or typical irritating cough, coughing up purulent sputum, high fever, and chest pain. The incidence of bronchopleural fistula after lung cancer surgery is 0.2%~20%; once it occurs, the mortality rate can be as high as 15%~71.2%. Therefore, patients with fever, chest pain, and coughing up purulent sputum after surgery should seek medical attention as soon as possible and undergo chest CT or chest X-ray examination. Bronchopleural fistula CT or chest X-ray can find signs of fluid and pneumothorax. Once bronchopleural fistula is diagnosed, it should be covered with an internal stent for occlusion as soon as possible. The earlier it is discovered, the easier it is to heal. The earlier the diagnosis, the milder the pleural cavity infection, the better the patient's general condition, and the greater the possibility of fistula healing.

12. How should lung cancer patients be followed up after surgery?

The first postoperative follow-up examination for lung cancer patients is usually conducted one month after surgery. The main purpose is to observe the postoperative recovery, whether there is pleural effusion, lung inflammation, lung re-expansion, etc., and also retain the baseline examination results for reference in later follow-up examinations. The purpose of the subsequent follow-up examinations is mainly to determine whether there is recurrence or metastasis. Generally, the follow-up examination is conducted every six months in the first four years, and once a year after four years. For some patients in the middle to late stages or with high tumor malignancy and high-risk factors, it is recommended to have a follow-up examination every three months in the first two years. Routine follow-up examinations include chest CT, upper abdominal color Doppler ultrasound or CT, lung cancer markers, cervical lymph node color Doppler ultrasound, head MRI, bone scan, etc., among which chest CT is a must-check item every time. A full set of examinations can be considered once a year. In addition, if other symptoms occur, targeted examinations are recommended.

Source: Chongqing University Cancer Hospital

Author: Cai Huarong

Audit expert: Jiang Yuequan

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