| Objectives: Due to the effects of multiple factors before and after operation, delayed gastrointestinal functional restoration could be found usually to influence nutrition and chemiotherapy of patients, and to increase the risk of adherence and other complications after operation, and more to elongate the length of stay. Its signs included elongated timing of anal exhaust, weak bowel sounds, abdominal pain and distention, nausea and vomiting, delayed eating time after operation. It was reported that abnormal functional restoration of gastrointestinal tract may have a relationship with many factors as diabetes mellitus, low protein, vago neurectomy, electrolyte disturbance, anesthesia influence, infection in abdominal cavity and so on. In this study, etiologic analysis of delayed functional restoration was completed retrospectively through the comparison of 73 cases of intestinal carcinoma on age, sex, the level of blood k+, albumin, ferrohemoglobin before operation, operation time, obstructive vomiting and with or not vago neurectomy. Immune status of patients after operation and effect of TCM-WM therapy on gastrointestinal functional restoration were observed prospectively. Methods: 73 cases of advanced intestinal carcinoma (proved by postoperative pathology) without dysfunction of heart, liver and kidney were selected and analyzed retrospectively from department of oncological surgery of the second hospital of HeBei medical university during 2002.9-2005.2. All cases had received D2 radical gastrectomy with general anesthesia, abdominal cavity perfusion of 5-fliorouracil, self-control analgesia after operation. Early complications and anastomotic block after operation hadn't been found in all cases. Patients were divided into delayed and undelayed groups (basing on the restoration time of gastrointestinal motion >4 days) and with or not manifest gastrointestinal symptoms (including abdominal distention, nausea, vomiting, and weak bowel sounds) after eating liquid diet. Etiologic analysis was completed through the comparison of two groups on age, sex, the preoperative level of blood K+, albumin, surgical time, disease types, with or no obstructive vomiting before operation and with or no vago neurectomy. 43 cases of intestinal carcinoma in this hospital during 2004-2005 were observed prospectively under same condition. Besides getting routine therapys as antibiotic, fluid replacement, nutritional support intravenously, They had received Shen Qi Fu Zheng Ye (250ml per day, ivgtt), a medicine of strengthening spleen and benefiting qi, for 12 days after operation. All cases were divided into delayed group (>4 days, 10cases getting Shen Qi Fu Zheng Ye as observing group ) and undelayed group (≤4days, 18 cases no getting Shen Qi Fu Zheng Ye as control group I ) basing on the timing of anal exhaust after operation. From the 4th day after operation, acupuncture in ZuSanLi, SanYinJiao, NeiGuan, TianShu was given to observing group by retention of needle for 20-30min after strong stimulation, and then given chinese medicine strengthening spleen and harmonizing the stomach for 4days after anal exhaust till recovery of normal diet. The level of T cell subgroups was compared between observing and control groups on day4 and day12 after operation. 11 cases(control group II) with delayed gastrointestinal functional restoration were selected by same criteria during 2003-2005, and given routine treatment and metoclopramide (10mg per day, iv) or motilium (10mg, t.i.d, taking orally). Their time of anal exhaust, defecation and normal diet recovery was recorded according to chief complaint and medical record of patients, and then compared with that of observing group. Results: 1. The comparison of preoperative influence factors between delayed and undelayed group Comparing with undelayed group, age composition of delayed group was significantly differences (57.65±13.16 y, vs 64.64±9.98y, p<0.05), and preoperative ferrohemoglobin level of it was significantly differences (102.96±25.57g/L vs 116.96±18.07g/L, p<0.05). The preoperative albumin level of delayed group was significantly differences than it of undelayed group greatly (38.46±4.07g/L vs 41.54±3.54g/L, P<0.05), but there was no significantly difference of blood k+ between two groups(4.26 ±0.43mmol/Lvs4.43 ±0.68mmol/L P>0.05), although these two observation indexes were in normal level. There was no significantly difference of patient's constituent ratio on sex, operation time and vago neurectomy between two groups too (p>0.05), but patients of obstructive vomiting and Billroth II gastrectomy in delayed group were in undelayed group (p<0.005). 2. The comparison of T cell subgroups level between observing and control groups I after operation At day4 after operation, the level of CD4~+ (25.05 ±7.08%vs30.42±5.75%)and CD4+/CD8+ (1.67±0.31vs2.27±0.49 )is significantly differences in observing group than in control group I (p<0.05), but no significantly difference of CD8+ (14.44±2.85%vs13.84±3.30%)could be found (p>0.05). At day12 after operation, the level of CD8~+ (16.98±4.63vs15.47±3.14)is no significantly differences in observing group than in control group I (p<0.05), at the same time there was no difference of CD4~+ (31.80±7.10vs32.79±4.17 )between two groups(p>0.05), and so the value of CD4~+/CD8~+ (1.96±0.55vs2.17±0.37)is no significantly differences in observing group (p<0.05). The difference of T cell subgroup level between at day12 and day4 after operation had been compared between two groups. The results showed that the difference of CD4~+ (6.77±1.08vs2.37±3.23)in observing group was significantly differences than in control group I (p<0.05), but the difference...
|
PDF Full Text Request