| Objective: Colorectal cancer is the second most commonly diagnosed cancer in humans.Rencetly,higher incidence of colorectal cancer has been seen in China,producing a threat to human health.It has reached consensus on radical resection may be best optimized for the treatment of colorectal cancer.Since Kehlet,a academic professor in Danish,posed a concept of fast track surgery(FTS)or enhanced recovery after surgery(ERAS)in 1997,the laparoscopic operation has been popularized and applied.The indwelling gastric tube being canceled or early removed is suggested in FTS/ERAS and is not consistent with our original ideas.Regularly,in most ares of our country,indwelling gastric tube is used before operation and removed after operation as the recovery of gastrointestinal function,However,many surgeons are afraid of some complications caused by canceling or early removal of indwelling gastric tube,and of poor prognosis and heavy burden brought by complications in colorectal cancer patients.Either reducing the use of gastric tube or adhering to the original approach in perioperation is still controversial.This study aims to explore clinical efficiancy between application of the rapid rehabilitation programs and traditional control programs.Methods: 94 cases of colorectal cancer patients visiting oncology and general surgery department were chosen during 2014.6~2016.9.The 94 patients is divided into control group,observation group1 and 2 randomly.29 patients removed indwelling gastric tube after the recovery of gastrointestinal function as control group and 34 patients after the recovery from anesthesia as observation group1.31 patients without indwelling gastric tube in perioperative period were considered as observation group2.In order to evaluate clinical efficiancy,the index were recorded after unified management as following: ? vomiting,cough,nausea,abdominal distension,throat pain,and postoperative hospital stay;? the anus exhaust time and defecation time;? aspiration,lung infection,low sodium hypokalemia,anastomotic leakage,intestinal obstruction,stomach bleeding and infection of incision.Results were presented as mean±standard deviation or median(interquartile range)for measurement data and percentage for count data.T-test and Mann-Whitney U/One-way ANOVA test was carried out for measurement data and chi-square test for count data statistical analysis with SPSS19.0 statistical software.Comparing mean of three sample,F tests were performed on the norm variablies,Wileoxon or Kruskal-Wallis rank tests had been done on the non-norm distribution data.A p-value of less than 0.05 or 0.017 was considered to be statistieally signifleant.Results: All patients survived during the observation period.after analyzing the characteristics of the selected patients in terms of sex?age?BMI and tumor site,there was no statistical difference among three groups.The comparative results of clinical efficiancy were shown as following: the control group of 29 patients,male 20 cases,female 9 cases,aged 35 to 79,an average of 60.48±9.58 years,BMI 16.26~32.95,23.53±3.52 on average,19 cases of colorectal cancer,4 cases of sigmoid colon cancer,litres of colon cancer in 5 cases,1 case of colon cancer,transverse colon cancer 0 cases;Observation 1 set of 34 patients,24 cases of male,10 women,aged 27~79,an average of 57.26±11.70 years,BMI 18.02 ~ 32.96,an average of 23.90±3.47,19 cases of colorectal cancer,6 cases of sigmoid colon cancer,6 cases of litres of colon cancer,1 case of colon cancer,2 cases of transverse colon cancer;Observed in 31 patients of two groups,male 16 cases,15 cases were female,aged 35 to 77 years old,average 59.65±11.26 years,BMI 20.30~31.21,25.06±2.66 on average,including 14 cases of rectal cancer,6 cases of sigmoid colon cancers,7 cases of litres of colon cancer,colon cancer 1 case,3 cases of transverse colon cancer.1 Postoperative complication:The control group and observation group1: the incidence of postoperative complication is lower except for aspiration and lung infection and low sodium hypokalemia in observation group1: cough(82.8% vs 5.9%,P=0.000,P< 0.017),nausea(79.3% vs 14.7%,P=0.000,P<0.017),throat pain(79.3% vs 11.8%,P=0.000,P<0.017),lung infection(13.8% vs 2.9%,P=0.171,P> 0.017)and low sodium hypokalemia(31.0% vs 17.6%,P=0.214,P>0.017).The control group and observation group2: the incidence of postoperative complication except for aspiration and lung infection is lower in observation group2: cough(82.8% vs 3.2%,P=0.000,P<0.017),nausea(79.3% vs 19.4%,P=0.000,P<0.017),throat pain(79.3% vs 3.2%,P=0.000,P<0.017),aspiration(0% vs 12.9%,P=0.113,P>0.05),lung infection(13.8% vs 12.9%,P=1.000,P>0.017),and low sodium hypokalemia(31.0% vs 6.5%,P=0.014,P<0.017).The observation group1 and 2: the incidence of aspiration was lower in observation group1 and no big difference was seen in other sides: cough(5.9% vs 3.2%,P=1.000,P>0.017),nausea(14.7% vs 19.4%,P=0.618,P>0.017),throat pain(11.8% vs 3.2%,P=0.358,P>0.017),aspiration(0% vs 12.9%,P= 0.046,P<0.05),lung infection(2.9% vs 12.9%,P=0.184,P>0.017),and low sodium hypokalemia(17.6% vs 6.5%,P=0.262,P>0.017).A variety of comparison among three groups: vomiting(P=0.390,P> 0.05),and abdominal distention(P=0.707,P>0.05),anastomotic leakage(P= 0.697,P>0.05),intestinal obstruction(P=0.757,P>0.05),and infection of incision(P=0.697,P>0.05).2 Anus exhaust time,defecation time and postoperative hospital stay:The control group and observation group1: the removal of indwelling gastric tube after recovery from anesthesia was more conducive to the recovery of gastrointestinal funcion,which reduced postoperative hospital stay for patients: the anus exhaust time(64h vs 46.5h,P=0.001,P<0.017),defecation time(70h vs 55 h,P=0.000,P<0.017),postoperative length of hospital stay(10d vs 7d,P=0.000,P<0.017);The control group and observation group2: compared with traditional practice,it was more conducive to the recovery of gastrointestinal funcion and less postoperative hospital stay without indwelling gastric tube: the anus exhaust time(64h vs 45 h,P=0.000,P<0.017),defecation time(70h vs 48 h,P =0.000,P<0.017),postoperative length of hospital stay(10d vs 7d,P=0.000,P <0.017);The observation group1 and 2: there was no big difference seen between observation groups,the anus exhaust time(46.5h vs 45 h,P=0.545,P>0.017),defecation time(55h vs 48 h,P=0.932,P>0.017),postoperative length of hospital stay(7d vs 7d,P=0.648,P>0.017).3 Summery of complications:The control group and observation group1: the total number of postoperative complications[4(3.5-5)vs 1(1-1),P=0.000,P<0.017];The control group and observation group2: the total number of postoperative complications[4(3.5-5)vs 1(1-3),P=0.000,P<0.017];The observation group1 and 2: the total number of postoperative complications[1(1-1)vs 1(1-3),P=0.288,P>0.017].Conclusions:1 There was good evidence that the application of the rapid rehabilitation programs to indwelling gastric tube can reduced the incidence of postoperative complications especially for cough,throat pain,nausea and lung infection,reducing the postoperative hospital stay.2 Patients pulling out indwelling gastric tube after recovery from anesthesia could reduce the incidence of mistake inhale and no big difference was seen in other sides compared to patients without indwelling gastric tube.3 The placement of indwelling gastric tube according to rapid rehabilitation surgery not only reduced the incidence of postoperative complications and hospital stay,but also was more conducive to the recovery of gastrointestinal function.Because this practice was not subject to economic and geographical constraints and conformed to the ERAS concept,it could be popularized for futher application. |
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