Enhanced recovery after surgery in total laparoscopic radical gastrectomy

中华普通外科杂志 Pub Date : 2020-01-25 DOI:10.3760/CMA.J.ISSN.1007-631X.2020.01.007

Yu Yu, Moucheng Zhang, Kaijun Gao, Liangwei Yang, Jiaming Zhou, Zhilong Yan

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Abstract

Objective To investigate the effect of enhanced recovery after surgery(ERAS) on immune function and postoperative recovery in gastric cancer patients undergoing total laparoscopic radical gastrectomy. Methods Patients were randomly divided into ERAS group and control group. Blood CD4+ , CD8+ , CD4+ CD25+ , C-reactive protein , postoperative recovery and complications were compared between the two groups. Results On day1, CD4+ , CD8+ , CD4+ CD25+ in the two groups were significantly lower than those before surgery (t=9.070, 7.297, 5.830, 12.870, 3.529, 10.547, all P 0.05) while the other indexes in the two groups raised but still were lower than preoperative level (t=3.322, 5.015, 3.418, 9.912, all P<0.05); CD4+ , CD8+ , CD4+ CD25+ in ERAS group were higher than control group (t=2.804, 2.040, 2.210, allP<0.05). On day5, CD4+ , CD4+ CD25+ in the two groups and CD8+ in ERAS group returned to the preoperative level, while CD8+ of the control group was still lower than the preoperative level (t=6.862, P<0.05). On day1, 3 and 5, the C-reactive protein levels of the two groups were higher than those before surgery(t=-13.338, -13.715, -11.319, -12.286, -13.182, -15.076, all P<0.05), and ERAS group were lower than the control group (t=-3.246, -2.100, -2.211, all P<0.05). There was no mortality in neither groups. The time of passage gas by anus, defecation, getting out of bed, oral feeding, and postoperative hospital stay in the ERAS group were less than those in the control group[(2.8±1.0)d vs. (3.9±0.9)d, t=-5.974; (3.8± 0.9)d vs.(4.3±1.0)d, t=-2.700; (19.1±4.0)h vs. (35.9±6.6)h, t=-16.045; (9.9±1.6)d vs. (11.5±2.0)d, t=-4.479, all P<0.05]. Conclusions ERAS in the perioperative period of patients with total laparoscopic radical gastrectomy mitigates the stress on the cellular immune system, reduces inflammatory response, and help fast recover the postoperative gastrointestinal function. Key words: Stomach neoplasms; Immunity, cellular; C-reaction protein; Enhanced recovery after surgery

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腹腔镜全胃根治术提高术后恢复

目的探讨增强术后恢复（ERAS）对癌症全腹腔镜根治性胃切除术患者免疫功能及术后恢复的影响。方法将患者随机分为ERAS组和对照组。比较两组患者血CD4+、CD8+、CD4+CD25+、C反应蛋白、术后恢复情况及并发症。结果术后第1天，两组CD4+、CD8+、CD4+CD25+明显低于术前（t=9.070、7.297、5.830、12.870、3.529、10.547，均P<0.05），其余指标均升高但仍低于术前水平（t=3.322、5.015、3.418、9.912，均<0.05）；ERAS组CD4+、CD8+、CD4+CD25+均高于对照组（t=2.804、2.040、2.210，均P<0.05）。第5天，两组CD4+和CD4+CD26+及ERAS组CD8+均恢复到术前水平，而对照组CD8+仍低于术前水平（t=6.862，P<0.05），两组患者C反应蛋白水平均高于术前（t=-13.338、-13.715、-11.319、-12.286、-13.182、-15.076，均P<0.05），ERAS组低于对照组（t=-3.246、-2.100、-2.211，均<0.05）。肛门通气时间、排便时间、下床时间、口饲时间、，ERAS组术后住院时间少于对照组[（2.8±1.0）d vs.（3.9±0.9）d，t=-5.974；（3.8±0.9）d.vs.（4.3±1.0）d.t=-2.700；（19.1±4.0）h vs.（35.9±6.6）h，t=-16.045；（9.9±1.6）d.vs.（11.5±2.0）d，t=-4.479，均P<0.05]细胞免疫系统，减少炎症反应，帮助术后胃肠功能快速恢复。关键词：胃肿瘤；免疫，细胞；C反应蛋白；术后恢复增强

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中华普通外科杂志

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