Objective To investigate the application progress of postoperative fluid administration in colorectal surgery. MethodsLiteratures about the advancement of fluid administration in colorectal surgery were reviewed and analyzed. Results Compared to standard fluid management, restrictive fluid administration could reduce the incidence of complications, the length of stay in hospital and improve postoperative survival rate. Colloid-crystalloid combined therapy was better than that pure crystal therapy. Conclusion Volume and type of rehydration influence postoperative recovery, which is also considered in “fast track” colorectal surgery.
ObjectiveTo investigate the feasibility and advantage of the da Vinci S Surgical System in operation of the mediastinal tumor without chest tube. MethodsFrom March 2011 up to March 2015, 39 patients in our hospital with mediastinal tumor underwent resection without a chest tube by da Vinci System were as a no chest tube group with 24 males and 15 females at age of 47.28 (18-73) years. In the same period, 50 patients with mediastinal cyst underwent resection with a chest tube insertion by da Vinci System were as a chest tube group with 25 males and 25 females at age of 49.24 (22-82) years. Clinical data of the two groups were collected and compared. ResultThere were statistical differences in mean operative time (61.97±16.41min vs. 79.90±33.19 min, P=0.003), time of ICU stay (1.23±0.48 d vs. 2.16±0.82 d, P=0.000), time of postoperative hospitalization (3.77±1.16 d vs. 5.62±2.22 d, P=0.000), and visual analogue scale (VAS) score (3.05±1.76 vs. 4.54±1.83). The clinical results in the no chest tube group were better than those in the chest tube group. All the procedures were successfully completed by da Vinci System in all the patients without conversions and any compilcation. ConclusionIt's safe and beneficial for patients without a chest tube after a mediastinal tumor resection with da Vinci S Surgical System with shorter hospital stay.
Objective To discuss the safety of fast track surgery for patients with obstructive colorectal cancer. Methods Between February 2008 and February 2009, 157 cases of obstructive colorectal cancer were analyzed retrospectively, 59 in fast track (FT) group and 98 in traditional group. Postoperative early rehabilitations and complications were studied and compared. Results The first time of passing flatus, oral intake and postoperative hospital stay in FT group were significantly earlier or less than those in traditional group （Plt;0.05）, while there were no significant differences in time of first ambulation, time with use of nasogastric tubes, urinary catheter, and drains between the 2 groups （Pgt;0.05）. There was also no statistically significant difference in postoperative complications rate between the 2 groups （Pgt;0.05）. Conclusion Fast track surgery for patients with obstructive colorectal cancer is safe and can accelerate recovery with decreasing length of hospital stay and improving life quality of the patients.
ObjectiveTo investigate the safety, feasibility, and efficacy of fast track surgery (FTS) in gastrointestinal tract injury. MethodsThe data of 61 patients with gastrointestinal tract injury from July 2007 to July 2013 were retrospectively analyzed, among whom 29 patients were received FTS (FTS group) and 32 patients were received conventional care (control group). The first flatus and defecation time, hospital stay, rates of wound infection and lung infection, and the mortality were compared between these two groups. ResultsThe average first flatus and defecation time and the average hospital stay in the FTS group were significantly shorter than those in the control group (2.21 d versus 3.16 d, P=0.000; 7.45 d versus 9.78 d, P=0.000). The rate of lung infection in the FTS group were significantly lower than that in the control group[3.4% (1/29) versus 21.9% (7/32), P=0.033]. The rate of wound infection and the mortality had no significant differences between the FST group and the control group[3.4% (1/29) versus 15.6% (5/32), P=0.111; 0(0/29) versus 3.1% (1/32), P=0.337]. ConclusionsFTS is safe and effective among those gastrointestinal tract injury patients who visited the hospital in time and injury limited. FTS could promote defecate, shorter the hospital stay, and don't increase the complications and mortality.
ObjectiveTo explain the latest concepts of colorectal surgery, and predict the future direction of it. MethodsA review and summary based on the clinical experience of our hospitals and theses over the past years and new advances on the researches in home and abroad were performed. ResultsDoctors should attach more importance to anal preserving operation; and there should be more usage of fast track in colorectal surgery. Besides, predicting low risk of postoperative complications and digitizing colorectal surgery also needed more attention. ConclusionThose aspects of colorectal surgery in the result need further development.
ObjectiveTo investigate the feasibility of thoracolapascopic esophagectomy (TLE) without routine nasogastric (NG) intubation for patients with esophageal cancer (EC). MethodsClinical data of 78 EC patients under-going TLE without perioperative NG intubation in Affiliated Cancer Hospital of Zhengzhou University from January to September 2013 were analyzed (non-NG intubation group, including 48 male and 30 female patients with their age of 61.1± 8.5 years). Seventy-eight EC patients undergoing TLE with routine NG intubation for 7 days in 2012 were chosen as the control group (NG intubation group, including 50 male and 28 female patients with their age of 60.3±7.0 years). Operation time, postoperative morbidity, gastrointestinal functional recovery and patient discomfort were compared between the 2 groups. ResultsThere was no in-hospital death in either groups. There was no statistic difference in the incidences of pulmonary infection (16.7% vs. 19.2%, P=0.676), anastomotic leakage (1.3% vs. 2.6%, P=0.560) or NG tube replacement (3.8% vs. 2.6%, P=0.649) between non-NG intubation group and NG intubation group. Time for recovery of intestinal motility (2.5± 1.1 days vs. 4.3±1.2 days, P < 0.05) and time for air evacuation (3.6±1.7 days vs. 5.8±2.1 days, P < 0.05) of non-NG intubation group were significantly shorter than those of NG intubation group. Ninety-seven percent of the patients (76/78)in NG intubation group had uncomfortable feeling including dry mouth and sore throat, and only 6% of the patients (5/78) in non-NG intubation group had nausea. All the patients were followed up for 3 months after discharge. There was no intestinal obstruction, pneumonia or late anastomotic leakage during follow-up. ConclusionTLE without routine NG intubation is safe and feasible for EC patients, which can not only reduce patients' discomfort but also improve early recovery of gastrointestinal function.
Objective To determine if laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising enables better perioperative and medium-term outcome than Ivor-Lewis cervical stapled esophagogastrostomy via thorax for middle esophageal carcinoma without intumescent lymphnode of neck. Methods The perioperative and medium-term outcome of a series of 55 patients underwent Ivor-Lewis cervical stapled esophagogas-trostomy via thorax between April 2010 and December 2012 were as a historic cohort (group A, 36 males, 19 females at age of 65±8 years). And 46 patients underwent laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising between January 2013 and March 2015 were as a prospective cohort (group B, 31males, 15 females at age of 66±7 years). Perioperative indexes, lymphadenectomy, and result at end of one year following up were compared. Results Compared with group A, there was shorter thoracic operation time (t=5.94, P < 0.05), shorter time of restored anus exhaust (t=2.08, P < 0.05), less pulmonary complication (χ2=3.08, P < 0.05) and less total perioperative complications (χ2=4.30, P < 0.05), shorter postoperative hospital stay (t=3.20, P < 0.05) in the group B. While no statistically significant difference was found between the two group in postoperative morbidity of circulation or digestive and associated with surgical techniques (all P>0.05), lymph node metastasis rate of cervico-thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.03, 0.15, 0.08, all P>0.05), lymph node ratio (LNR) of cervical thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.01,0.71, 0.01, all P>0.05), recurrence rate of tumour (χ2=0.04, P>0.05), or survival rate (χ2=0.13, P>0.05) one year after the surgery. Conclusion Laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising is a more rational surgery of cervicothoracic and cervical paraesophageal lymph nodes dissection via intrathoracic instead of cervical approach for middle esophageal carcinoma.
ObjectiveTo investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. MethodsA total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group (n=89) and FTS group (n=82). Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein (CRP) and interleukin-6 (IL-6) levels in serum were observed postoperatively. ResultsFor the FTS and control group, the first exhaust time was respectively (2.4±0.3) and (3.3±0.6) days, postoperative hospital stay was (9.1±2.7) and (14.1±4.1) days, hospitalization expense was (16 432±3 012) and (21 612±1 724) yuan, all of which had significant differences (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively (8.57±2.58), (30.21±12.44), (17.41±11.73), (11.14±7.12), and (10.50±5.19) ng/L, and for the control group was respectively (9.13±2.99), (51.31±19.50), (36.82±12.33), (28.23±9.18), and (15.44±4.33) ng/L. There was no significant difference in the preoperative IL-6 level between the two groups (P>0.05), while IL-6 level was significantly lower in the FTS group than the control group after surgery (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively (18.41±4.01), (69.74±26.03), (45.52±20.50), (39.14±11.23), and (29.03±6.47) μg/L, and for the control group was respectively (17.74±2.11), (99.23±23.50), (86.81±17.34), (68.22±15.60), and (37.70±9.55) μg/L. There was no significant difference in the preoperative CRP level between the two groups (P>0.05), while CRP level was significantly lower in the FTS group than the control group after surgery (P<0.05). Postoperative complication rate after surgery was not significantly different between the two groups (P>0.05). ConclusionThe application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.
Objective To evaluate the use of fast track surgery （FTS） in the treatment for cholecystolithiasis combined with calculus of common bile duct （CBD） by combination of laparoscope and duodenoscope. Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecyst-ectomy （LC） and endoscopic retrograde cholangiopancreatography （ERCP） were divided into FTS group （n=55） and conventional group （n=65），which were accepted the perioperative therapy of FTS or conventional therapy，respectively. After operation，the incision pain，nausea and vomiting，infusion time，loss of body weight，out-of-bed time，dieting time，postoperative hospitalization，hospital costs，and complications were compared in two groups. Results Compared with the conventional group，the postoperative infusion time，dieting time，out-of-bed time，and postoperative hospitali-zation were shorter，the incidence rates of pulmonary infection，and urinary systems infection，pancreatitis，nausea and vomiting， and incision pain were lower，the loss of body weight was lower in the FTS group （P＜0.05），but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P＞0.05）. Conclusion The FTS is safe，economic，and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.
Objective To explore the application of fast track surgery (FTS) mode through multidisciplinary cooperation for the perioperative period of liver cancer. Methods A total of 188 patients with liver cancer treated between April and December 2014 were randomly divided into two groups: FTS group (n=94) and control group (n=94). The FTS group was treated with multidisciplinary cooperative FTS mode, while the control group was treated with traditional perioperative treatment. The self-care ability of daily life, pain, ambulation time and frequency, anal exhaust time, defecation time, hospital stay, hospitalization expenses and readmission rate were compared between the two groups. Results Compared with the control group, patients in the FTS group had a better ability of self-care one to three days after surgery, more reduced pain 8, 24 and 48 hours after surgery, more frequent ambulation and longer ambulation time three days after surgery, shorter time of defecation and exhaust, shorter hospital stay and lower hospitalization expenses. All the above differences were statistically significant (P<0.05). The readmission rate, self-care ability four to seven days after surgery, pain scores 72 and 96 hours after surgery were not significantly different (P>0.05). Conclusion Multidisciplinary cooperative FTS mode for liver cancer perioperative rehabilitation can improve patients’ self-care ability, promote a speedy recovery, reduce hospitalization costs, save medical resources and improve disciplinary teamwork ability.