Clinical Application Of Rapid Rehabilitation Surgery In Gynecological Malignant Tumor Surgery

Fast track surgery(FTS) is a multiple evidence-based strategy,which conformity and optimize a series of perioprative interventions. The concept of FTS includepreoperative assessment,fasting,avoiding bowl preparation, anesthesia and analgesia,minimal invasive surgery,perioprative nursing ect.FTS aimed at enhancing recovery after surgery, reducing complications,shorterning length of stay and reaching cost-effective.In recent years,FTS seemed to benefit gynecology surgery, although so far have scarcely been reported.Our review summarizes current evidence concerning use of fast-track in general and in gynecological surgery and make a wish to the development in the future.ObjectiveTo evaluate efficacy, safety and cost-effectivenessof fast track surgery(FTS) proceduresin people with gynecologic malignancy and provide the basis for clinical practice.MethodsWe searched CNKI,VIP,Pubmed, EMBASE and Cochrane library databases.Literature, related reviews and abstracts in English or Chinese for relevant randomized and non-randomized controlled trialscomparing patients treated with FTS procedures with patients treated regularly before December 31st,2014. We estimated standard mean difference(SMDs) for measurement dataand odds ratios (ORs) for categorical data with STATA 12.0.Results3 randomized trials and 5 non- randomized trials were included.The length of stay(LOS)in FTS group is significantly shorter than control group.(SMD=0.724,95% CI (0.449～0.999), P<0.001)).Patients in FTS group have much shorter flatus time (SMD=0.644,95% CI(0.273～1.014), P=0.001)and postoperative recovery time of enteral nutrition (SMD=0.688,95% CI (0.393,0.982, P<0.001).Complication rate, mortality and recurrence in FTS groupwas significantly differentwith control group. FTS group more and there was no statistically significant difference in mortality (OR=0.93,95% CI (0.20,4.21, P =0.925); once. Furthermore,FTS group lower the expense in the hospital than the control group significantly(SMD=0.423,95% CI (0.245,0.245), P< 0.001).ConclusionFTS procedures are safe in patients with gynecologic malignancy,which enhance recovery from gynecologic surgery.Objective To explore the influence of gynecologic malignant tumor patients with postoperative rehabilitation of the related factorsMethodA retrospective analysis of effect of 490 cases of gynecologic malignant tumor patients with postoperative hospital stay, complications and prognosis after surgery and postoperative rehabilitation targets related factors, for the clinical indicators, clinical pathologic factors of single factor analysis, through a variety of statistical methods to screen out the single factor analysis results are more factors.Result The related factors which influenced the postoperative hospital stay including the time of surgery (P<0.001), the indwelling time of gastric tube (P=0.042), surgery type (P=0.007), detaining time of urinary catheter (P<0.001), surgery (P=0.016), postoperative hemoglobin (P=0.003), time of indwelling drainage tube (P<0.001).Related factors influencing the postoperative complications including bowel resection surgery (OR:4.04,95%CI:1.54～10.59,P=0.004), albumin levels after surgery (OR:0.92,95%CI:0.93～0.99,P=0.022), detaining time of urinary catheter (OR:1.35,95% CI:1.17～1.57,P=0.000), P<0.05. Among the relevant factors affecting overall survival in patients with stage(HR:11.25,95%CI:1.57-80.89,P=0.016), albumin levels after surgery (HR:0.89,95%CI:0.79-0.99,P=0.040) and preoperative chemotherapy (1.54, 95%CI:1.48～14.79,P=0.009).ConclusionThe gynecologic tumor patients postoperative hospital stay, complications of its prognostic factors, and for the future rapid rehabilitation surgery (FTS) model is established to improve patients postoperativeehabilitation to provide the basis.ObjectiveTo explore the effectivity and safety of laparoscopic surgeryand the influencing factors of fast recovery in early stage cervical cancerMethods A retrospective analysis from January 2010 to November 2013 early cervical cancer patients with stage (Ⅰ AⅡ A) data, according to age, clinical pathological characteristics in patients undergoing laparoscopy and laparotomy case-control analysis.Comparing two groups operation indicators, postoperative complications and follow-up results, and the factors influencing the cavity mirror group of patients with postoperative hospital stay were analyzed.Result The cavity mirror and laparotomy group postoperative hospital stay, and preoperative fasting time, operation time, intraoperative rehydration fluids, postoperative morphine dosage of analgesic, and postoperative complications in the two groups is no statistical difference.Bleeding amount of cavity mirror group less than laparotomy group (200 ml v.s.350 ml, P<0.001), intraoperative blood transfusion rate low (3.9% v.s.20.6%, P< 0.001).(3 d cavity mirror group of patients with postoperative exhaust time v.s.3 d P= 0.021).V.s. defecation time (3 d 4 d P=0.026), shorter than laparotomy group, intestinal function recovery faster.Cavity mirror group of antibiotics in patients with time (2 d v.s.5 d, P <0.001), the drainage tube indwelling time shorter than laparotomy group patients (3 d v.s.4 d, P=0.003).Two groups of DFS and OS were 98.7% and 100% respectively,97.7% and 83.3%, there were no statistically significant difference (P> 0.05).Factors influencing the rapid recovery of early cervical cancer laparoscopic surgery:operation time, intraoperative rehydration, postoperative urine tube indwelling time, P< 0.001).Conclusion laparoscopic surgery has less intraoperative blood loss, postoperative fast recovery of used in early stage cerical cancer is safe and feasible, medium-term follow-up effect is satisfactory.Influencing factors by the explore the patients’ rapid recovery, provide evidence for early cervical cancer laparoscopic surgery FTS model is set up in the future.