| The purpose and significance of the overall research: Intestinal microflora is the most important component of intestinal biological barrier,and its function depends on the stability of human body's internal and external environment.Previous studies have reported the protection of intestinal biological barriers by early postoperative enteral nutrition and the use of increased glutamine after operation.It is also reported that intestinal biological barriers are protected by improving perioperative treatment.But the above studys are limited to a single factor to protect the intestinal biological barrier.The mode of Enhanced Recovery After Surgery(ERAS)integrates perioperative evidence-based medical measures,which helps to maintain the stability of intestinal biological barrier.This study closely around the core issue of "intestinal barrier" maintenance,By detecting the number of six kinds of predominant bacteria in Bifidobacterium,Lactobacillus,Bacteroides,Clostridium,Clostridium leptum and enterobacteria in the feces of gastric cancer patients,the changes of the two groups of D and lactic acid concentration were also changed.It aims to explore:(1)Whether the Enhanced Recovery After Surgery model is better than traditional surgery in themaintenance of intestinal barrier stability;(2)Whether the Enhanced Recovery After Surgery combined with laparoscopic technique--the "combination" in the maintenance of intestinal barrier stability is more advantageous?.By this way,bring a better perioperative treatment strategy for patients with gastric cancer and improve the level of treatment for gastric cancer in our area.Methods: This study recruited 106 patients with stage I-III gastric cancer in November 2016—January 2018.These patients after admission in patients informed consent,divided into:(1)30 people in the open surgery group of the traditional surgical mode(referred to as: the conventional laparotomy group);(2)30 people in the laparoscopic surgery group of the traditional surgical mode(referred to as: traditional laparoscopic surgery group);(3)24 people in the open surgery group of the enhanced recovery after surgery model(referred to as:ERAS laparotomy group);(4)22 people in the laparoscopic surgery group of the enhanced recovery after surgery model(referred to as: ERAS laparoscopic surgery group).Each group was treated according to the surgical mode of the enhanced recovery after surgery and the traditional surgical mode for the perioperative period.Clinical observation index:(1)The first exhaust time after operation in each group;(2)The time of hospitalization in each group;(3)The incidence of postoperative complications in each group: pulmonary infection,urinary tract infection,anastomotic fistula,intestinal obstruction,vomiting / nausea /abdominal distention.Collection and detection of fecal specimens:(1)Take the stool specimens of each group before operation;(2)Take the stool specimens of the first defecation of the patient after the operation.Intestinal permeability test: before and first,third,seventh days afteroperation,the concentration of two amine oxidase(DAO)and the concentration of D lactate were measured in the plasma of the patients.Results:1.There was no difference in age,sex and tumor pathological staging between the four groups.2.The incidence of postoperative complications in two ERAS group was lower than that in two traditional surgical groups,but there was no significant difference in the incidence of postoperative complications between the four groups.3.The changes in fecal bacteria:(1)for different surgical modes,there were significant differences in the number of bacteria between the postoperative enhanced recovery after surgery group and the traditional group;(2)For the different operation methods in the enhanced recovery after surgery mode,there was no significant difference in the number of bacteria except for the number of Bifidobacterium and Bacteroides among the number of bacteria in ERAS laparotomy group and ERAS endoscopic group.4.The change of plasma two amine oxidase(DAO):(1)there was no significant difference in the value of DAO before operation;(2)For different surgical modes,the DAO value of the ERAS group were less than the one of traditional group at 1 days after operation,3 days after operation,and 7 days after the operation respectively.(3)For different modes of operation in ERAS mode,the ERAS endoscopic group was lower than the ERAS group in 1 days,3days after operation and 7 days after operation respectively,but there was no significant difference in DAO value between two treatment groups.5.D-lactate concentration changes:(1)there is no significant difference in plasma D-lactate concentration in each group before operation;(2)for differentsurgical models,on the 1 day after operation,although the plasma D-lactate concentration in the ERAS group was lower than that in the traditional group,there was no statistically significant difference between the two groups.There was a significant difference in plasma D-lactate concentration between the two groups at 3 days after operation and 7 days after operation respectively.(3)for different methods of operation in ERAS mode: At 1 days after operation,3 days after operation,and 7 days after operation,although the number of ERAS endoscopic group was lower than that of ERAS laparotomy group,there was no significant difference in D-lactate concentration between two treatment groups.Conclusion:1.Comparison of the safety and effectiveness of the enhanced recovery after surgery model with the traditional model(1)The enhanced recovery after surgery model and the combination of enhanced recovery after surgery and laparoscopy are safe and do not increase the incidence of postoperative complications observed,but enhanced recovery after surgery can shorten the recovery time of postoperative intestinal function and postoperative hospital stay;(2)Under the mode of enhanced recovery after surgery,laparoscopic surgery can improve clinical parameters,but has no obvious advantage over laparotomy.2.Effect of surgical treatment mode on intestinal biological barrier after operation(1)Compared with the traditional mode,the enhanced recovery after surgery mode can better protect the intestinal biological barrier;(2)Compared with the simple practice of enhanced recovery after surgery,enhanced recovery after surgery combined with laparoscopic surgery can bettermaintain the intestinal biological barrier,but the effect is limited;(3)Compared with the mode of operation,the perioperative treatment measures play a decisive role in maintaining the stability of intestinal biological barrier in gastric cancer patients. |
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