Fast Track Surgery In Patients With Gastric Cancer Postoperative Effect Of Inflammatory Reactions And Complications

Objective :To observe the fast track surgery treatment( fast track surgery,fts) on different age Patients with Gastric Cancer Postoperative Inflammatory effects and complications,exploring the mechanisms for promoting rapid rehabilitation of patients after operation and its clinical value.Methods:The fiber gastroscope and abdominal CT examination results in 126 patients with gastric cancer were diagnosed as a case set, included in the standards- setting and exclusion standard.According to the age is divided into less than or equal to 64 patients( 63 cases) and greater than or equal to 65 patients( 63 cases) two groups and each group according to different treatment methods are divided into the rapid rehabilitation group( FTS, the experimental group) and traditional treatment group( CC, the control group),That is less than or equal to 64- year-old Group for the rapid rehabilitation of patients with treatment groups( fts-1,32 cases) and traditional treatment group( cc-1,31cases), and greater than or equal to 65- year-old Group for the rapid rehabilitation treatment groups( fts-2,31 cases) and traditional treatment group( cc-2,32 cases). All the groups of patients after the extraction of venous blood before surgery 1 days respectively, after 1 days and 3 days,applying double antibody sandwich Elisa for the Detection of serum concentration of IL-6, il-10, and TNF-α,and using luminescent assay for the quantitative Detection of serum PCT concentration.Using spss19.0 data analysis of statistical software, If two independent samples of measurement data apply T test comparisonin line with the normal distribution, if they do not meet the normal distribution and the homogeneity of variance using rank- sum test,Measurement data use the standard deviation and average of V form; for a comparative analysis of count data,it uses N(%) form, for a statistical analysis of count data using chi- square test or Fisher’ S exact test.Test standards to a=0.05 as a standard, when P ﹤ 0.05 shows statistically difference.Results:Different age paragraph in patients with general information features comparison,including age, gender, surgery time, ASA scoring, surgery type, reconstruction type,tumor tnm staging stage, and complications( hypertension disease, and cardiovascular disease, and lung disease, and diabetes, and kidney disease)( These index p>0.05),however, in addition to different age paragraph in patients with age differences of statistics significance( p<0.05,), four group in patients with other any features do not have an explicit differences( all p>0.05,).Different ages paragraph in the fast- track surgery groups elevated lower than traditional treatment groups over the same period with serum PCT of postoperative 1 days,3 days and proinflammatory cytokines IL-6 and TNF-α levels, however,the level of serum anti- inflammatory cytokines IL-10 elevated above traditional treatment groups over the same period, and these statistical analysis of the significant difference was statistically significant( p<0.05). The postoperation Clinical Observation of recovery situation for : 1)In fast rehabilitation Surgical group the first time exhaust time and hospital time of the postoperation were obvious shortened respectively for [( 3.2 v 0.6 days and 3.5 v 0.5days, P = 0.021) and( 6.2 v 1.4 days and10.0 v 2.2 days,p = 0.000) ], however, study on the FTS-2 and CC-2 groups showed the they did not heve explicit differences,that is for [( 3.4 v 0.3 and 3.6 v 0.3 days, P=0.053) and( 10.1 v 1.5 and 10.8 v 1.2days,p = 0.056) ].2) Compared with the traditional treatment group, the total cost is significantly lower with the fast track surgery group for( 36.3 v 2.8 å'Œ 38.0 v 3.1thousand dollar, P =0.025), but no significant difference between fts-2 and cc-2 groups, the group is(40.9v 1.5 and 41.7v1.8 thousand dollar,P =0.061).3) The hospitalization rates again in the 30 days after the postoperation had no significant differences between the FTS and CC groups,they was statistically significant( p>0.05). The comparison of the postoperative Complications :1) In the FTS-2 group the incidences of postoperative pulmonary infection and urinary tract infections were significantly lower than traditional treatment groups for [( 3 / 31,and 10 / 32 people,P= 0.034), and(2/ 31å'Œ9 / 32 people,P=0.023)], but they were no significant difference between FTS-1 and CC-1 groups( P = 0.670,P = 0.368 and P =0.638);2) Between FTS-1 and CC-1 groups were no significant difference in the incidence of the postoperative Nausea and Vomiting(5 / 32 and 3 / 31 people, P=0.741),however, the FTS-2 group increased significantly(9 / 31 and 3 / 32 people, P=0.047);3) in fast track surgery group, postoperative intestinal obstruction in incidence decreased significantly(3 / 32 and 9 / 31 people, P = 0.047), but between fts-2 and cc-2groups no significant difference(3 / 31 and 5 / 32 people, P = 0.741); 4) in the same age paragraph range, between the different treatment groups postoperative complications rate,there were no significant differences(such as gastric retention, urinary retention,anastomotic fistula, wound infection, deep venous thrombosis of lower limb formation)(all P > 0.05).Conclusion :1. Fast Track surgery is less trauma for surgery patients of gastric cancer, it can significantly reduce inflammatory response of postoperative patients.3)The fast- track surgery group significantly reduced the incidence of postoperative Ileus( 3 / 32 and 9 / 31 people,P =0.047), but they had no significant difference between the FTS-2 and the CC-2 Group(3 / 31 and 5 / 32 people,P =0., 741);4)In the same age range, between the different treatment groups had no significant difference in the incidence of the postoperative complications( such as sore throat, gastric retention, urinary retention, cuts infection, and anastomotic fistula, Deep Venous Thrombosis of Lower Extremities)( all p>0.05).2.For young patients with gastric cancer surgery( meal 64 years old), rapid rehabilitation surgery treatment can reduce the incidence of postoperative ileus, reduce the postoperative flatus time and postoperative hospital stay, reduce the total cost of hospitalization.3. For elderly patients with gastric cancer surgery( 65 years old), fast track surgery in the Treatment can reduce Postoperative Nausea and Vomiting the, and incidence of pulmonary infection and urinary tract infections,and have no effect on the postoperative anus exhaust time, hospital stay and the total cost of.4. Rapid rehabilitation of surgical treatment in patients with gastric cancer have no effect on postoperative anastomotic leakage, sore throat, stomach retention, urinary retention, wound infections and Venous Thrombosis of Lower Limb and the number of hospitalized again.