Effect Of Gastrointestinal Hormone In Serum Of Patients After Laparoscopy-assisted Gastrectomy For Gastric Cancer

ObjectiveResearch show that postoperative inhibition of gastrointestinal movement in tradition abdominal surgery is obviously, which was affected by operation and anesthesia. Seriously, there would be postoperative gastroparesis, intestinal pseudo obstruction and so on.Which prolong the recovery time and increase physical pain of the patients. The application of laparoscopy improve the postoperative recovery from reduced trauma and postoperative complications. Reseaches have show that changes of gastrointestinal hormones correlated to the gastrointestinal movement under operation. But few reports concering about the relationship between gastrointestinal hormones and laparoscopic surgery. So we evaluated the changes of serum levels of three gastrointestinal hormones: motilin(MTL), vasoactive intestine peptide(VIP) and somatostatin(SS) in two group of gastric cancer patients, who receiving either radical laparoscopy-assisted or open gastrectomy. Meanwhile the recovery of postoperative gastrointestinal function was also recorded. The purpose of this study was to investigate the changes of gastrointestinal hormones effects on gastrointestinal function postoperative and the possible mechanism after laparoscopy-assisted gastrectomy. We want this research can provide some instructions for further application of laproscopy technology in clinical treatment and postoperative care.METHODS(1) Samples collectionThis study included two groups of 56 patients with gastric cancer receiving gastrectomy in our department. From March to Octobe 2008, 30 patients were performed by laparoscopy, the other 26 patients received open gastrectomy. Fast venous blood was taken as follow: prior to operation,24h ,48h and 72h after operation. Samples were collected and centrifugated, then separated plasma samples were stocked -80℃until assayed. All patients have no abdominal surgery before this hospitalization, no obstruction and distant metastasis were detected preoperative. Liver and renal function were normal in all patients. Patients had no diabetes, no radiotherapy and chemotherapy preoperative. Drugs affect gastrointestinal motility and secretion of gastrointestinal hormone were permitted perioperative.Two groups were anesthetized under general anesthesia, all patients receive radical distal gastrectomy with D2 lymphadenectomy. The gastric cancer of all patients were diagnosed by endoscopy examination preoperative and pathological biopsy postoperative.(2) Determination of gastrointestinal hormonesThe serum level of MTL, VIP and SS were determined by radioimmunoassay (RIA). Serum levels of MTL,VIP and SS in samples were tested by competitive binding reaction with non-equilibrium method.(3) Observation of the recovery of gastrointestinal functionPatients were auscultated for as long as five minutes in each of the four quadrants of the abdomen to determine whether bowl sounds were present. We presumed the recovery of bowel sounds only if the bowel sounds were auscultated more than 3 times/min in two or more of the quadrants. The first flatus postoperative was also recorded.RESULT(1) Radical distal gastrectomy with D2 lymphadenectomy was performed successfully in all patients either by laparoscopy-assisted or open technology. No specific postoperative complications were observed in patients in hospital. There were no significant difference of serum MTL,VIP and SS levels preoperative between two groups (P>0.05)(2)Serum levels of MTL in both groups were significantly decreased compared with those of the preoperative period (P<0.05). However levels of MTL in laparoscopic group were higher than those in open group in 24,48 and 72 postoperative hours (P<0.05). They returned to preoperative level at 72h after operation in laparoscopic group, but we did not observe those in open group at the same time.(3)Meanwhile serum levels of VIP in two groups were significantly higher than those of the preoperative period. The serum VIP levels in laparoscopic group were lower than those date in open group in 24 and 48 postoperative hours (P<0.05). It returned to preoperative levels at 48 hours after operation in laparoscopic group, but the recovery time is 72 hours in open group. (4) Serum levels of SS in two groups both decreased significant with the levels of preoperative(P<0.05). There were no significant difference of levels of SS postoperative between two groups, except for open group were significant higher than those in laparoscopic group 48 postoperative hours. And the levels of SS were still significant lower than preoperative levels in both groups in 72 postoperative hours.(5)The recovery time of bowel sounds and first flatus postoperative in laparoscopy group were both significant shorter than the time of open groups (P<0.05).(6)Postoperative serum levels of MTL were positive correlated with the time of bowel sound recovery and first flatus after operation in two groups(P<0.05). Meanwhile postoperative serum levels of VIP were negative correlated with those date in two groups(P<0.05). But serum levels of SS has no correlation with those date in both groups(P>0.05).CONCLUSION(1) Laparoscopy-assisted gastrectomy had significant less effects on serum level of MTL, VIP than open gastrectomy. The recovery time of serum level of MTL and VIP in laparoscopy group were faster than those in open group.(2) The recovery time of bowel sounds and first flatus postoperative were significant shorter in laparoscopic group.(3)The recovery period of gastrointestinal movement was shorter in gastric cancer patients treated by laparoscopy than in those by laparotomy. One of the reasons probably correlated with the less changes of some gastrointestinal hormone.