Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
Objective To discuss the impacts of completion rate of fast track items on postoperative management of colorectal cancer surgery. Methods Between February 2010 and May 2010, 100 patients (Group “Year 2010”) were analyzed retrospectively, who were compared with 76 patients (Group “Year 2008”) from the same period of 2008. Postoperative recovery indexes, complications, and completion rate of fast track items were studied and compared. Results For major fast track items, the completion rates of restrict rehydration, early out-of-bed mobilization, early oral intaking, and management of gastric tube and drains were significantly higher in Group “Year 2010” than those in Group “Year 2008” (Plt;0.05). Meanwhile, the completion rate of urinary catheter management was significantly higher in Group “Year 2008” than that in Group “Year 2010” (Plt;0.05). In early rehabilitation, the first flatus of patients in Group “Year 2010” 〔(3.86±1.05) d〕 was significantly earlier than that in Group “Year 2008” 〔(4.28±1.22) d〕, Plt;0.05; for postoperative hospital stay, though, there was no statistically significant difference between two groups (Pgt;0.05). As to the complications, there was also no statistically significant difference between two groups (Pgt;0.05). Conclusions As the concepts of fast track surgery became increasingly favorable, completion rates of fast track items are increased. As a result, more and more fast track items turn into regular perioperative care. Although enhanced recovery has been achieved, better collaboration and localilzation are still needed to make the full advantage of fast track surgery.
ObjectiveTo study clinical value of perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of fast track surgery (FTS). MethodsThe clinical data of 268 patients were analyzed retrospectively, who underwent laparoscopic cholecystectomy in the Department of General Surgery, the 2nd Hospital of Baiyin City from July 2013 to July 2015. All these patients were divided into FTS group and traditional group according to the chronological order, 133 patients in the traditional group were performed traditional perioperative analgesia before August 31, 2014, and 135 patients in the FTS group were performed perioperative multimodal analgesia method based on the concept of FTS after September 1, 2014. The data of both groups were collected and analyzed, including point of numerical rating scale, intestinal function recovery time, intake food time, ambulation time, drainage tube duration, postoperative hospital stay, postoperative sleep time at 72 h, and complications. Results①The points of numerical rating scale at 1 h, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h in the FTS group were significantly lower than those in the traditional group (P < 0.01).②Compared with the traditional group, the intestinal function recovery time, intake food time, ambulation time, drainage tube duration, and postoperative hospital stay were obviously shorter, the postoperative sleep time at 72 h was obviously longer in the FTS group.③The incidence of nausea and vomiting in the FTS group was significantly lower than that in the traditional group (P < 0.01), the incidences of the other complications such as acid reflux, urinary retention, and breathing difficulty had no significant differences between these two groups (P > 0.05). The satisfaction rate of postoperative analgesic effect in the FTS group was significantly higher than that in the traditional group (P < 0.01). ConclusionsPerioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of FTS is safe and effective. It could achieve painless effect of laparoscopic cholecystectomy.
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 evaluate the effect of fast track surgery (FTS) on clinical parameters and postoperative complications in patients with abdominal aortic aneurysm (AAA). MethodFifty Patients with AAA treated in our hospital between December 2009 and May 2015 were enrolled in this study. Ten patients between December 2009 and December 2012 received conventional standard care (conventional group), while 50 between January 2013 and May 2015 received FTS (FTS group). The first exhaust time, the first time of off-bed activities, the duration of hospital stays, and the complications after AAA surgery were analyzed. ResultsThe first exhaust time of patients in the FTS group and conventional group was (2.5±0.9) and (4.0±1.1) days; the first time of off-bed activities was (2.9±1.0) and (4.1±0.9) days; and the duration of hospital stays was (13.5±2.1) and (17.9±2.8) days. All those differences were significant (P<0.05). The incidences of incision infection, renal inadequacy, lower limb swelling, and weakened gastric function in the FTS group were significantly lower than those in the conventional group (P<0.05). On the third day after surgery, C-reactive protein in the FTS and conventional group was respectively (57.5±9.0) and (65.0±13.1) mg/L, and interleukin-6 was respectively (10.2±3.9) and (15.5±5.1) pg/L, both of which were significantly different between the two groups (P<0.05). ConclusionsFast track surgery is effective and safe in patients with abdominal aortic aneurysm, and it may lower trauma stress after surgery and incidence of postoperative complications.
Objective To explore the advantages of postoperative chest drainage with 16F urinary catheter for video- assisted thoracoscopic surgery (VATS) lobectomy. Methods Data of 102 patients (October to December 2015) who under- went VATS lobectomy of lung disease with insertion of catheter (16 F urinary catheter or 28 F chest tube) were analyzed. The patients were divided into two groups including a 16F group (49 patients, with 16 F urinary catheter) and a 18F group (53 patients, with 18F chest drainage tube).The following post-operative data were evaluated: primary healing of tube inci- sion, chest X ray abnormalities (pneumothorax, pleural effusion, subcutaneous emphysema, and hematoma), drainage time, re-insert the drainage tube, and wound healing at the site of insertion. Results Both groups were similar in age, gender, co-morbidity and pathological evaluation of resected specimens. After adjustment, no statistically significant difference was found between the two groups in pulmonary complications (30.6% vs. 28.3%, P=0.102), subcutaneous emphysema (60.0% vs. 6.7%, P=0.011), required intervention (2.0% vs. 5.7%, P=0.048). The average total drainage volume in the 16F group (587.3±323.7 ml) was less than that of the 28 F group (824.1±444.3 ml, P=0.000). The rate of primary healing at the site of insertion in the 16 F group (100.0%) was higher than that in the 28F group (58.5%, P=0.014). A significant difference was found in the drainage time and post-operative length of stay between the two groups (54.2±28.6 h vs. 95.6±65.5 h，4.2±1.4 d vs. 6.5±3.0 d). Conclusion Since 16F urinary catheter has advantage in fast track rehabilitation and low risk of pulmonary complications, the use of 16F urinary catheter is appropriate after VATS pulmonary lobectomy.
ObjectiveTo evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery.MethodsWe retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). ResultsThere was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups.ConclusionTubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.
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.
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 impact of chronic obstructive pulmonary disease (COPD) and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery. MethodClinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients (39 males and 14 females) with their average age of 56.31±10.51 years, and non-COPD group including 76 patients (37 males and 39 females) with their average age of 65.92±7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery (VATS) group including 83 patients (44 males and 39 females) with their average age of 61.62±10.80 years, and routine thoracotomy group including 46 patients (32 males and 14 females) with their average age of 62.95±9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups. ResultsThere was no statistical difference in postoperative morbidity (53% vs. 40%, P=0.134)or average hospital stay[(7.66±2.95) days vs. (7.36±2.74)days, P=0.539] between COPD group and non-COPD group. Postoperative morbidity (34% vs. 65%, P < 0.001)and average hospital stay[(6.67±2.52)days vs. (8.61±3.01) days, P < 0.001] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost (￥44 542.26±11 447.50 yuan vs. ￥23 634.13±6 014.35 yuan, P < 0.001) and material cost (￥37 352.53±11 807.81 yuan vs. ￥12 763.08±7 124.76 yuan, P < 0.001) of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group (￥7 473.54±4 523.70 vs. ￥10 176.71±6 371.12, P < 0.001). There was no statistical difference in other cost between VATS group and routine thoracotomy group. ConclusionVATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.