The Clinical Study Of Effect Of Different Intestinal Preparation On Serum Bilirubin In Patient After Liver-carcinomectomy

Objective:Comparison of the bowel cleansing effectiveness, the impact on postoperative serum bilirubin, patients' compliance, as well as side effects of different methods of bowel preparation before liver resection for hepatocellular carcinoma (HCC). To provide a scientific recommendation for physicians and nurses about oral bowel cleansing preparations in current surgical management of hepatocellular carcinoma.Methods:A total of 120 patients undergoing bowel preparation before hepatectomy for HCC were randomized to 1 of 4 different preparation regimens and received oral 25% magnesium sulfate (A group), sodium phosphate (NaP)(B group), polyethylene glycol-electrolyte lavage solution(PEG-ELS)(C group), and lactulose (D group).Each oral administration was divided into oral drug simply (A1,B1,C1,D1) and oral drug+ cleansing enema (A2,B2,C2,D2) two sub-groups, and took corresponding bowel preparation intervene according to the various sub-groups, collected relevant data of patients in the study, established database, applied descriptive analysis, chi-square test, rank sum test, variance analysis, multi-factor Logistic regression analysis,etc. to analyze and distinguish their intestinal cleanliness, postoperative bilirubin level, patients'compliance, side effects, electrolyte disturbances, intestinal function recovery and the postoperative complications, etc. Results:1,In terms of cleansing effectiveness:The cleanliness quality was statistically higher in the magnesium sulfate group,NaP group and PEG-ELS group than in the lactulose group(P<0.05);The diarrheal lasting time was longer in the PEG-ELS group than in the others, Differences were statistically significant (P<0.05). Differences in cleanliness quality between oral drug simply (A1,B1,C1,D1) sub-group and oral drug+ cleansing enema (A2,B2,C2,D2) sub-group were statistically not significant(P>0.05).2,In terms of bilirubin level:①The bilirubin level was statistically higher on day 1,3,5,7 after operation than before operation, differences were statistically significant (P<0.001).②the TBIL,DBIL,IBIL level on day 1,3,5,7 after operation were higher in B group than in A group, Differences were statistically significant (P<0.05).③the TBIL,DBIL,IBIL level on day1,3,5,7 after operation were higher in B1,D1 groups than in A1,C1 groups, Differences were not statistically significant.④which also were higher in B2 group than in A2,C1,D2 groups, Differences were not statistically significant.⑤the bilirubin level on day1,3,5,7 after operation was higher in B1,B2,D1groups than in A1,A2,D2 groups. D1 was at the highest, A2 was at the lowest, C1,C2 were in the middle. difference in bilirubin level between A2 and D1 was statistically significant (P<0.05), the remaining groups showed no statistical difference.⑥the incidence of hyperbilirubinemia on the first day after operation was statistically higher in B1,D1 groups than in A1,C1 groups(P<0.05), which was also statistically higher in B2 group than in A1,C1,D1 groups(P<0.05).⑦Single factor analysis:Comparison of 18 clinical and pathological factors of the postoperative hyperbilirubinemia occurred 1day, results showed that: Preoperative liver function score, preoperative oral different laxative, blood loss, intraoperative blood transfusion, the total infusion volume in surgery, preoperative TBIL,DBIL. IBIL level, tumor diameter, capsule integrity, operation time are major factors of postoperative hyperbilirubinemia.⑧Multivariate Logisticregression analysis showed that preoperative liver function score, TBIL, intraoperative blood transfusion volume were risk factors for hyperbilirubinemia occurring after resection of liver cancer; while preoperative oral magnesium sulfate, PET-ELS catharsis are protective ones.3,In terms of Patients' compliance:The complete compliance was statistically poorer in magnesium sulfate group(23.3%) than in PEG-ELS group(56.7%),NaP group (63.3%) and lactulose group(90%). differences between the groups were statistically significant (P<0.001).4,In terms of side effects:The overall incidence of side effects include moderate and severe such as nausea,vomiting and celialgia was recorded in PEG-ELS group (20%). magnesium sulfate group (13.3%). NaP group (13.3%) and Lactulose group(3.3%), Lactulose has less side effects, but There were no Statistically significant differences(P>0.05).5,there was a slight drop in Na+,P3+,Ca2+,CL on the first day of postoperation but showed no statistical differences between each groups (P>0.05). The decrease in Mg2+ was lower in A1 group than in D1,groups, Differences were statistically significant (P<0.05).The recovery rate of postoperative intestinal function ranked from high to low were NaP group,lactulose group. PEG-ELS group and magnesium sulfate group, each groups showed statistical difference (P<0.05).but the oral drug simply sub-group and oral drug+ cleansing enema sub-group has no statistical difference in the recovery rate of intestinal function. Surgical complications among the groups showed no significant difference. Conclusion:1,preoperative oral magnesium sulfate, PEG-ELS catharsis help reduce postoperative incidence of hyperbilirubinemia, promote earlly postoperative recovery,which are worthy spreadly application in clinical.2,Oral magnesium sulfate,PEG-ELS are safe,fast,effective means in the preoperative bowel preparation for patients with hepatocellular carcinoma, oral medication alone got satisfactory bowel cleansing effect, which can cancel the work of cleansing enema and release the suffering on patients, but in terms of taste, tolerance and compliance, PEG-ELS is superior to magnesium sulfate.3,oral NaP is a safe, fast, effective and well-tolerated bowel cleaning drug, and it has little side effect, well-done in postoperative recovery of gastrointe-stinal function, but in reducing the level of bilirubin,NaP is secondary to magnesium sulfate, Lactulose and PEG-ELS.4,Lactulose has good characteristics in terms of side effects,patient tolerability, compliance, but an oral lactulose has not yet reached a satisfactory bowel cleansing effect. And it is secondary to magnesium sulfate, and PEG-ELS in the impact of postoperative bilirubin.