| Objective At present,the most important treatment for gastric cancer is surgery,supplemented by radiotherapy and chemotherapy or targeted therapy.The benefits of Enhanced Recovery after Surgery(ERAS)for gastric cancer patients have been widely recognized in surgery.However,the concept is currently only applicable to general patients,and patients with specific comorbidities,such as diabetes,are still excluded from the criteria,as these patients do not yet benefits of Enhanced Recovery after Surgery.However,the situation of diabetes in China is increasingly serious,and the number of people diagnosed with diabetes is increasing year by year,which is a group that cannot be ignored.In clinical work,the method of applying the concept of Enhanced Recovery after Surgery to these patients is of great research value.Objective To confirm the safety and feasibility of Enhanced Recovery after Surgery for patients with gastric cancer complicated with type 2 diabetes,and to explore the effect and mechanism of Enhanced Recovery after Surgery on postoperative inflammatory response and intestinal microflora in patients with gastric cancer complicated with diabetes.MethodsFifty-five patients with gastric cancer complicated with type 2 diabetes who underwent laparoscopic radical gastrectomy for gastric cancer in gastrointestinal Surgery department of Jiangsu University Affiliated Hospital from October 2020 to November 2021 were selected strictly according to the inclusion criteria and divided into two groups.The first group was ERAS group,a total of 25 patients entered the Enhanced Recovery after Surgery’s pathway during perioperative period.The other group,non-ERAS,was performed in the traditional perioperative approach for gastric cancer,with 30 patients.The preoperative and postoperative indicators of the two groups were observed and compared,including the general indicators of the patients:age,gender,obesity index,BMI,preoperative hba1 c,and related indicators of stress level: The levels of C-reactive protein(CRP),interleukin 6(IL-6)and white blood cell count(WBS),changes in blood glucose levels before and after surgery,and indicators of nutritional status before and after surgery were compared.The total protein,albumin,prealbumin and lymphocyte indexes of patients were compared before operation and 1,3,5 and 7 days after operation.Postoperative intestinal function related indicators: first postoperative anal exhaust time,abdominal drainage tube and nasal and intestinal tube removal time,postoperative total length of hospital stay;And the changes of intestinal flora in patients before and after surgery.Results1.There was no significant difference between the two groups in preoperative general data including age,gender composition,BMI index,course of diabetes,h BA1 c index,blood glucose control method,ASA grade,NRS2002 score,etc.(P > 0.05).There were no significant differences between the two groups in the operative methods,operative time,total intraoperative blood loss,total number of dissected lymph nodes,TNM stage and other intraoperative general data(P > 0.05).2.There were no significant differences in preoperative stress-related indicators CRP,IL-6 and WBS between ERAS group and non-ERAS group(P > 0.05).In addition,the overall trend of inflammation indicators in both groups increased first and then decreased throughout the whole operation and operation,and the stress indicators in ERAS group decreased more rapidly than those in non-ERAS group,and the CRP indicators in ERAS group were different from those in non-ERAS group on day 5 and7 after operation(P < 0.05).There were differences in IL-6 index on postoperative day 1,3 and 5 compared with non-ERAS group(P < 0.05),and WBS index on postoperative day 1 compared with non-ERAS group(P < 0.05).3.There was no significant difference in preoperative blood glucose levels between the two groups(P > 0.05).On day 1 after surgery,fasting blood glucose levels in both groups were significantly higher than those before surgery,and in the overall trend,the fasting blood glucose levels in ERAS group were lower than those in control group,and the increase was significantly lower than that in control group,especially on day 3 and 6 after surgery(P < 0.05).There was no difference in blood glucose levels between the two groups on the morning of surgery(P < 0.05).On the day of surgery,blood glucose measurements were significantly elevated before entering the operating room and were more elevated in the experimental group(P < 0.05).;After operation,blood glucose levels in both groups showed a trend of increasing first and then becoming stable.In ERAS group,the upward trend was more gentle than that in the control group,and the overall blood glucose level was lower than that in the control group(P < 0.05).4.There were no significant differences in preoperative nutrition-related indexes between the two groups(P > 0.05).The nutritional status-related indicators of patients in the two groups decreased first and then increased,and the patients in ERAS group had a higher overall nutritional indicator level.The total albumin level in ERAS group on day 1 after surgery was significantly higher than that in control group,and the albumin level on days 3,5 and 7 after surgery in ERAS group was significantly higher than that in control group,the prealbumin level in ERAS group was significantly higher than that in control group,the lymphocyte count level in ERAS group was significantly higher than that in control group on the 5th and 7th day after surgery(P< 0.05).5.The time of first postoperative anal exhaust in ERAS group was significantly shorter than that in control group(P < 0.05).Patients in ERAS group had earlier removal of abdominal drainage tube and naso-intestinal tube than those in control group(P < 0.05).ERAS group also significantly shortened compared with control group(P < 0.05).6.There was no difference between ERAS group and non-ERAS group in the number of intestinal flora before surgery(P > 0.05),and the number of bifidobacteria,lactobacillus and Escherichia coli in the two groups after surgery decreased compared with that before surgery,and compared with non-ERAS group,In ERAS group,the numbers of bifidobacteria,Lactobacillus and Escherichia coli after surgery were higher overall(P < 0.05).ConclusionEnhanced Recovery after Surgery(ERAS)concept used in gastric cancer combined with type 2 diabetes is safe,feasible,and can reduce the postoperative patients with stress level,maintaining blood glucose in patients with postoperative stability,improve the level of patients with postoperative nutrition,promote the intestinal function recovery,to maintain intestinal flora in patients with the environment,so as to accelerate the postoperative recovery of patients... |
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