Enhanced Recovery Strategies In Robotic Gastrectomy:To Discuss The Best Time Of Early Catheter Removal For Postoperative Gastric Cancer

Objective:Enhanced recovery strategies in robotic gastrectomy:to discuss the best time of catheter removal for postoperative gastric cancer.Methods:This research is designed by the method of randomized controlled trials, from January 2015 to June 2016 in gastrointestinal department of Nanjing General Hospital of Nanjing Military Command. All the gastric cancer patients are randomly divided into three groups:remove urethral catheter after surgery immediately; remove urethral catheter after surgery for 12 h; remove urethral catheter after surgery for 24 h. Every group own 50 patients. Three groups are received the same ERAS perioperative treatment and care. General data include:gender, age. Intraoperative clinical baseline data include:total amount of liquid, fluid total amount, urinary volume, duration of surgery, anesthesia, anesthetic drug kinds, anesthesia awaken after extubation time, perioperative pain medications. Postoperative clinical observations include:the number of urination after first time catheter removal, the number of catheter reset after first time catheter removal, the number of urinary irritation after first time urination, the number of abnormal routine urine test after first time catheter removal, the first micturition pain score, first bed activity time, first aeration time, postoperative hospitalization days, total hospitalization days, total hospitalization expenses.Results:1. Three groups of patients before operation and completed before urethral catheter general data survey, the baseline assessment. Gender, age, intraoperative total amount of liquid, fluid total amount, urinary volume, duration of surgery, anesthesia, anesthetic drug kinds, anesthesia awaken after extubation time, perioperative pain medications differences are no statistical significance (P> 0.05), comparable.2. Most of the patients (> 90%) can pee normally. The number of urination after first time catheter removal, the number of urinary irritation after first time urination, the number of abnormal routine urine test after first time catheter removal, the number of urinary retention after first time catheter removal, postoperative micturition pain score for the first time have no statistically significant differences (P> 0.05).3. Three groups of patients with early postoperative ambulation, first ventilation time difference was statistically significant (P< 0.01). Immediate postoperative extubation and postoperative 12 h group in the early postoperative ambulation, for the first time, ventilation is statistically significant (P< 0.05). Immediate postoperative extubation group less than 12 h after decannulation.12 h after extubation and postoperative 24 h group in the early postoperative ambulation, for the first time, ventilation is statistically significant (P< 0.05), after 12 h group less than 24 h after extubation. Immediate postoperative extubation and postoperative 24 h group in the early postoperative ambulation, for the first time, ventilation is statistically significant (P< 0.05), Immediate postoperative extubation group less than 24 h postoperatively.4. Three groups of patients with postoperative hospitalization days and total hospitalization days and total hospitalization costs are statistically significant (P< 0.01). Immediate postoperative extubation with 12 h after decannulation group in postoperative hospitalization days and total hospitalization days and total hospitalization costs more obvious difference (P> 0.05). Extubation after 12 h and 24 h after decannulation groups.12 h after the extubation and 24 h after decannulation group in postoperative hospitalization days and total hospitalization days and total hospitalization costs have statistical difference (P< 0.05),12 h after extubation group is superior to the 24 h after decannulation. The immediate postoperative extubation group and 24 h after decannulation in postoperative hospitalization days and total hospitalization days and total hospitalization costs have statistical difference (P< 0.05). Immediate postoperative extubation group is superior to the 24 h after decannulation.Conclusion:1.Compared with other two groups, remove urethral catheter after surgery immediately group is safe, no increase in discharge risk of complications. Immediate postoperative urethral catheter was not significantly increased in patients with pain discomfort.2. Remove urethral catheter after surgery immediately can promote early ambulation time, the early aeration and rehabilitation.3. Remove urethral catheter after surgery immediately can promote patients early recovery, reduce the total hospitalization days and total hospitalization expenses.