| Background and Objective: Elderly patients with gastric cancer(GC) have decreased physiological function, decreased systemic organ function, poor tolerance to traumatic stress and malnutrition, which affect postoperative recovery. Enhanced recovery after surgery (ERAS) advocated the adoption of a series of optimization measures to reduce the patient's psychological, physiological trauma and stress response, to achieve the purpose of rapid postoperative recovery. The advantages of laparoscopic small trauma and postoperative rehabilitation cater to the concept of ERAS. In this study, we used ERAS combined with laparoscopic technique in the treatment of elderly patients with gastric cancer, to study its safety and effectiveness, and to explore its influence on nutritional status and stress response in elderly patients with gastric cancer, in order to seek the perioperative management of small trauma, stable internal environment, good nutritional status, small stress response, and rapid postoperative recovery for patients with gastric cancer, especially in elderly patients.Methods: Elderly patients diagnosed as gastric cancer by pathology were selected from September 2015 to August 2016.After the evaluation, 84 patients without surgical contraindications and surgery were selected,and were randomly divided into four groups:Group A (ERAS+laparoscopic surgery,21 cases),Group B (ERAS+open surgery,21 cases),GroupC (traditional perioperative management+ laparoscopy,21 cases),Group D(traditional perioperative management+open surgery,21 cases). Each group were carried out radical gastrectomy for gastric cancer followed the corresponding procedure, and the general data of sex, age, body mass index (BMI), modus operandi, anastomosis method and pathological stage were recorded. We study from the following aspects:(1) safety and effectiveness index: recorded the duration of operation, blood loss, incision length,number of lymph nodes, anal exhaust time, postoperative hospital stay, total cost of hospitalization, complications of the four groups;(2) nutritional status index: Preoperative NRS2002 screening method was used to evaluate and guide nutritional therapy.We recorded and compared the changes of albumin ( ALB ) , prealbumin(PA) and transferrin(TRF) levels at the time of 1 days before operation, the postoperative day 1, the postoperative day 4, and the postoperative day 7 of the four groups; We calculated and recorded the nutritional evaluation index (NCI) of the four groups on 1 day before operation, postoperative day 4 and postoperative day 7; (3) recorded and compared the C reaction protein (CRP) , interleukin -6(Il-6) and serum amyloid protein A(SAA) levels at the time of 1 days before operation, the postoperative day 1, the postoperative day 4, and the postoperative day 7 of the four groups.Results: (1) There was no significant difference between the four groups in age, sex,BMI, complication, TNM stage, surgical resection, anastomosis and the number of lymph nodes dissection. Laparoscopic operation group (Group A, C) compared with the laparotomy group (Group B, D),the operation duration was longer, the amount of bleeding was less, and the incision length was shorter (P <0.05).(2)Index of postoperative recovery: ?First anal exhaust time, length of stay: The shortest patients were A, and the longest patients weres D(P <0.05).?The total cost of hospitalization: For laparoscopic operation,the total cost of Group A managed by ERAS was significantly lower than that of the Group C managed by traditional method(P<0.05);For laparotomy, the total cost of Group B managed by ERAS was significantly lower than that of the Group D managed by traditional method(P<0.05)?Postoperative complications:There was no significant difference in postoperative complications between the four groups (P >0.05).(3) Nutritional status indicators: After the operation, the nutritional status of the four groups were reduced to varying degrees, of which A group was the lowest, the fastest, the D group was the largest, the slowest. The difference was statistically significant (P<0.05).(4) Stress response level: 1 days after operation, the levels of CRP, IL-6 and SAA were significantly increased in the four groups, among which, the A group had the smallest increase, and the D group had the largest increase(P<0.05). 4 days after operation, CRP and SAA levels of four groups continue to rise, the rising amplitude of Group A was the smallest, that of Group D was the highest,while the IL-6 level began to decline, Group A also showed the fastest decline, Group D decreased most slowly (P<0.05). 7 days after operation, CRP, IL-6 and SAA of four groups were significantly decreased (P <0.05), The CRP, IL-6 and SAA levels in Group A were the lowest, the highest in Group D (P <0.05).Conclusion: 1.The treatment of Fast-track surgery combined with laparoscope in elderly patients with gastric cancer is safe and feasible, help to promote the recovery of intestinal function, shorten hospitalization time, reduce the total cost of hospitalization, accelerated postoperative recovery.2.Fast-track surgery combined with laparoscopy in the treatment of elderly patients with gastric cancer, postoperative nutritional status is better, can accelerate the recovery of patients..3.Traditional perioperative management and laparotomy for elderly patients with gastric cancer caused severe trauma, large stress response.Fast-track surgery combined with laparoscopic surgery can effectively reduce the body trauma and the level of stress response.4.Fast track surgery or laparoscopic used alone in elderly patients with gastric cancer,it also has the effect of promoting postoperative rehabilitation, nutritional and reducing the stress response,there was no difference in the effects, joint application effect is better. |
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