| Objective:To study the safety.feasibility and clinical effect of Enhanced Recovery after surgery of distal laparoscopic radical gastrectomy,and to provide a basis for popularizing Enhanced Recovery after Surgery in the perioperative period of Totally Laparoscopic Distal Gastrectomy for gastric cancer patients.Method:70 patients with gastric cancer who were eligible for elective surgery were selected from SIR Run Run Shaw hospital affiliated to Zhejiang university from June 2012 to June 2017.According to the perioperative management mode and surgical procedure,patients were divided into two groups using the random number table method:TLDG+ERAS and TLDG.The two groups were treated by the same surgeons and anesthesiologists.The experimental group was treated with the Enhanced Recovery after Surgery concept,and the control group with routine perioperative preparation.The clinical examination data of the two groups were recorded:1.Preoperative basic conditions:gender,age,BMI(kg/m2),gastric wall tumor size and TNM staging(UICC/AJCC,2010 edition);detection and recording of total serum protein(TP),serum albumin(ALB)and white blood cell count levels 1 day before surgery.2.Surgical index:the total length of the surgical incision,the time spent on surgerv,the amount of intraoperative blood loss,and the total number of D2 lymph node dissection.3.Postoperative indicators:pain scores after seven days(numerical rating scale).first anal exhaust time,time to get out of bed,hospitalization time,total hospitalization expenses,intravenous infusion days,feeding fluid time,complications;total serum protein(TP),serum albumin(ALB)levels on the 1st.3rd.and 7th day post operation were recorded.The stress indicators white blood cell counts on the 1st,3rd,and 7th day post operation were detected and recorded.4.After 4 weeks of follow-up,the patient’s recovery after discharge was observed:tumor recurrence,metastasis and survival.The rate of re-hospitalization after surgery was counted.Results:1.The preoperative indexes(age,gender,BMI.tumor size,TNM stage,total serum protein,albumin,and stress index)were comparable between the two groups(all p>0.05).2.Compared with TLDG group,first exhaust time,length of stay,hospital costs,consumption of liquid of TLDG+ERAS group were lower(p<0.05),statistically significant,but the incidence of postoperative complications in patients was not statistically significant(p>0.05).3.The postoperative indexes(total serum protein,serum albumin,pain score and white blood cell count)in the TLDG+ERAS group were superior to the control group(P<0.05),which was statistically significant.Postoperative total protein and albumin were consistently higher than the TLDG group,and the decline trend was moderate.There were no tumor metastasis and recurrence in the follow-up of-the two groups,and there was no difference in the rate of readmission(all 0).Conclusion:1.The concept of Enhanced Recovery after Surgery is safe and reliable for Totally Laparoscopic Distal Gastrectomy.The clinical effect is obvious and feasible.2.Compared with the traditional perioperative mode,patients with ERAS mode have faster recovery of postoperative gastrointestinal function,less traumatic stress response,superior analgesic effect,significantly shortened hospital stay and reduced hospitalization costs.3.ERAS is a key factor in accelerating the rapid recovery of patients with gastric cancer.ERAS combined with laparoscopic surgery has significant advantages and is worthy of clinical promotion. |
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