Clinical Study Of Accelerated Rehabilitation Surgery In Laparoscopic Assisted Radical Gastrectomy

BackgroundGastric cancer is one of the most common malignant tumors in China,with the morbidity and mortality ranking the second place.In terms of treatment,comprehensive treatment,mainly surgery,occupies a dominant position.For the surgical treatment of gastric cancer,radical gastrectomy is the main surgical method.The incidence of perioperative complications is 20%~46%,the perioperative mortality is 0.8%~10%,and the postoperative hospital stay is 8~13 days.Higher incidence of perioperative complications leads to longer hospital stay and higher hospital costs.Enhanced recovery after surgery(ERAS)or fast-track surgery(FTS)was first initiated by Danish surgeon H Kehlet in the field of colorectal surgery in the 1990 s.ERAS of core elements include: perioperative fluid management,minimally invasive technology,the best pain control,early started oral feeding and early mobilization,etc.,these factors make the incidence of perioperative complications,the patient's overall mortality and hospitalization time of patients,hospitalization expenses significantly reduced,greatly improved the patient's quality of life and postoperative recovery.Because of ERAS 'significant advantages,it quickly spread around the world.Since the application of laparoscopy in gastrointestinal surgery in the 1990 s,after continuous improvement and development,laparoscope-assisted radical gastrectomy has been widely used in patients with gastric cancer and achieved good results.However,ERAS has less research in the application of laparoscopic-assisted radical gastrectomy,which will be discussed in this paper.ObjectiveTo investigate the clinical effect of rapid rehabilitation surgery in patients undergoing laparoscopic-assisted radical gastrectomy.MethodThe study was a prospective,controlled study.Patients diagnosed with gastric cancer were recruited from the gastrointestinal surgery department of the first affiliated hospital of Zhengzhou university from March 2017 to February 2018 to participate in the study.During this period,a total of 75 eligible gastric cancer patients were divided into ERAS group and control group.All patients underwent D2 radical gastrectomy.In the ERAS group,38 cases were informed by ERAS(oral and written information about the operation and postoperative rehabilitation plan).The ERAS informed the patients to take 10% glucose water orally 1000 ml at 10 o 'clock in the evening before the operation.The patients could have a liquid diet within 6 hours before the operation.The gastric tube was indwelling after the patient was successfully anesthetized in the operating room.Intraoperative conventional heat preservation,restrictive fluid infusion.Patients were able to drink small amounts of water on the day of surgery and were gradually introduced to a tolerable diet.Encourage early movement out of bed.The routine nursing group included 37 patients.The patients stopped eating and drinking at 24 hours one day before the surgery.The routine education,surgical preparation,eating after the postoperative patients' exhaust,and the patients were informed that they could get out of bed according to their wishes and other measures.Clinical outcomes were recorded and evaluated,including first exhaust time,white blood cell count,hospitalization cost,length of stay,VAS score(visual analogue scale),levels of inflammatory cytokines TNF-and il-6(using ELSIA kit purchased from Shanghai Kanglong biotechnology co.,LTD.),and other clinically relevant indicators such as routine complications.ResultsWhite blood cell count(WBC)was compared between the two groups before surgery,1 day after surgery and 3 days after surgery.WBC of the ERAS group was 5.171 0.643 109/L,12.256 1.103 109/L,10.587 1.497 109/L,and WBC of the control group was 5.397 0.534 109/L,16.049 1.689 109/L,14.152 1.733 109/L,respectively.The WBC of the ERAS group one day before surgery was significantly lower than that of the control group(P=0.102),and the WBC of the ERAS group one day and three days after surgery was significantly lower than that of the control group(P<0.05).The ERAS of the patients' first exhaust time after surgery was 51.870 5.052 hours in the ERAS group and 61.680 6.549 hours in the control group.Gastric tube extraction time in ERAS group was 0.821 0.668 days,while in control group was 2.865 0.855 days.The hospital stay in ERAS group was 8.760 2.149 days,and that in control group was 11.700 2.171 days.Hospital expenditure ERAS group was 4.53 0.68 million yuan,while the control group was 5.23 0.74 million yuan.In ERAS group,patients' first exhaust time,gastric tube extraction time and hospitalization time were shortened compared with the control group,and the hospitalization cost was reduced compared with the control group,with statistically significant differences(P<0.001).The VAS scores in the ERAS group were 5.237 1.197,3.826 0.989 and 2.371 0.713,respectively.The VAS scores in the control group were 6.730 1.144,5.349 1.060 and 3.787 0.851.The contents of TNF-and il-6 in the two groups were compared on the first day before surgery and the first day after surgery.The difference in TNF-and il-6 in the ERAS group one day before surgery was not statistically significant(P > 0.05).In terms of postoperative complications,the ERAS rate was 10.526% in the group and 29.730% in the control group(P=0.038),with statistically significant difference.However,there was no significant difference in postoperative complications between the two groups.The above results indicate that ERAS concept is safe,feasible and economical in the perioperative period of gastric cancer.ConclusionsBased on the current studies,the perioperative management of ERAS is safe and feasible,and the concept of ERAS has important application value in the treatment of gastric cancer.