Clinical Observation Of Warm And Humidified Insufflation CO₂ Gas On Patients With Colorectal Cancer

Background:Laparoscopy induces less pain,short recovery time,short incision and many other advantages compared with open surgery.Both of them have the similar clinical efficacy.The laparoscopy is being widely used in abdominal surgery gradually.In the field of colorectal surgery,a number of prospective randomized clinical trial demonstrated that laparoscopic assisted colon cancer surgery does impart significant clinical benefits on blood loss,post-operative intestinal recovery,early oral feeding and short hospitalization in comparison to those in the open surgery[1-4].It's generally believed that warm and humidified insufflation gas in laparoscopic surgery is conducive to the recovery of patients after surgery.In addition,the time during laparoscopic colon surgery is relatively long?according to a study by Vestweber et al.in 224 cases of colon surgery with the average operation time was 166min?,that means more insufflation CO₂ gas is to be needed to maintain pneumoperitoneum.Therefore,warm and humidified CO₂-induced pneumoperitoneum may reflect the more obvious advantages on recovery compared with the standard dry and cold CO₂-induced pneumoperitoneum.But in the colon surgery field,the corresponding research is less,lack of clinical evidence to support this view strongly.This study is based on these purpose.Using humidified and warm gas to provide a physiological intra-abdominal environment?37 C,98%RH?to evaluate the effects on body temperature,postoperative pain,stress response,intestinal recovery,in order to provide the basis for laparoscopic surgery for patients with colon cancer,the results are reported as follows.Objective:We collected clinical data of 133 cases of colon cancer patients who received warm and humidified CO₂-induced pneumoperitoneum or standard cold and dry CO₂-induced pneumoperitoneum,then evaluated the relevant data of these two groups,intraoperative and postoperative recovery,to explore the whether the warm and humidified CO₂-induced pneumoperitoneum in laparoscopic assisted radical surgery on colorectal cancer can make clinical benefits.Method:One hundred and thirty three patients underwent laparoscopic assisted radical recection of colon cancer in the Department of Gastrointestinal surgery of Japan Union Hospital of Jilin University between July 2015 and September 2016 were randomly divided into two groups,the warm and humidified CO₂?37 ?,RH 98%?pneumoperitoneum group?n=66?,standard CO₂?20-23?,RH 0%?pneumoperitoneum group?n=67?,postoperative body temperature,pain,intestinal recovery,postoperative stress response,were included to investigate the differences between the warmed and humidified CO₂ and the standard CO₂ pneumoperitoneum in the treatment of colon cancer.Results:1.The impact of warm and humidified pneumoperitoneum or standard cold and dry pneumoperitoneum on the body temperatureBefore operation,no statistically significant difference?P > 0.05?between the two groups was found on body temperature?36.42±0.42 ? in warm and humidified pneumoperitoneum group,36.55±0.32? in standard cold and dry pneumoperitoneum group?.After 30 minutes of operation,the temperature of the patients in the warm and humidified pneumoperitoneum group did not fluctuate significantly,while the body temperature of the standard pneumoperitoneum group decreased,with a gradual downward trend,and reached the lowest level at the end of the operation.2.The impact of warm and humidified pneumoperitoneum and standard cold and dry pneumoperitoneum on pain in peroperative period1 hours after operation,there is significant difference?P<0.05?between the two groups with postoperative visual pain scores?VAS??3.20±1.23 in warm and humidified pneumoperitoneum group,4.46±1.29 in standard cold and dry pneumoperitoneum group?.The pain scores of the two groups were the maximum value 1 hour after the surgery,then the standard pneumoperitoneum group showed a gradual downward trend.the pain scores of standard cold and dry pneumoperitoneum were higher than those of the warm and humidified pneumoperitoneum group.And between the two groups,the difference on postoperative pain scores of first,6,12 hours after surgery was the most significant.3.The impact of warm and humidified pneumoperitoneum andstandard cold and dry pneumoperitoneum on stress responseEffect of CRP in peripheral bloodThe CRP concentration in the peripheral blood of the two groups before operation was 5.29±1.71 mg/dl in warm and humidified pneumoperitoneum group and 5.15±1.36 mg/dl in standard cold and dry pneumoperitoneum group.there was no significant difference between the two groups?P>0.05?.The concentration of CRP in peripheral blood of two groups reached peak value at the end of 12 hours after operation and then decreased gradually at 24 hours.At each time point after operation,concentration of CRP in warm and humidified pneumoperitoneum group was lower than that in standard gas pneumoperitoneum group,and there were significant differences at the time points of 12 hours?24 hours and 48 hours after operation?P <0.05?.72 hours after operation,CRP concentrations were similar,there is no statistical difference.Effect of IL-6 in peripheral bloodAt the beginning of the operation in two groups,IL-6 concentrations in peripheral blood of patients were 21.18±6.36 pg/ml and 20.44±7.54 pg/ml,there was no significant difference between the two groups?P>0.05?;the concentrations of IL-6 in peripheral blood both significantly increased after the operation,both the peak appeared at 24 hours after operation,and then decreased gradually.The concentrations of IL-6 in 12 h,24h and 48 h in warm and humidified pneumoperitoneum group were lower than those in standard cold and dry pneumoperitoneum group,and the difference was statistically significant?P < 0.05?.Effect of TNF-?in peripheral bloodTNF-? concentrations in peripheral blood of these two groups both increased at the time point of 12 h after operation,Compared with IL-6 and CRP,the range of increase was not obvious,but there was still statistical significance.The concentration of TNF-? decreased at 48 hours after operation,and there was no significant difference between the two groups at 72h?P>0.05?.4.The impact of warm and humidified pneumoperitoneum and standard cold and dry pneumoperitoneum on intestinal function recoveryThe time of first bowel sounds of the two groups was 47.30±4.83 hours in warm and humidified pneumoperitoneum group and 55.36±6.17 hours in standard cold and dry pneumoperitoneum group respectively,with significant difference between the two groups?P<0.05?;In the first flatus time after operation,the warm and humidifiedpneumoperitoneum group and standard cold and dry pneumoperitoneum group showed more significant differences,which were 86.75±4.22 hours and 96.52±3.59 hours respectively,also with the first defecation time which showed statistical significance?P<0.05?.There was no significant difference between the two groups in the incidence of small bowel obstruction,and only 2 cases of small bowel obstruction occurred in all of the 2 groups.The 2 cases were treated with ultrasonic therapeutic apparatus,oral urografin,electroacupuncture of Zusanli point and other non-operative treatment before relieving obstruction.Conclusions: Warm and humidified CO₂-induced pneumoperitoneum could provide a physical environment closer to the normal human body,effectively recovered and protected the temperature of patients with laparoscopic colorectal resection,reduced the intraoperative and postoperative hypothermia,accelerated the recovery of gastrointestinal function.It could also reduce postoperative pain and the early postoperative stess response.This trial provides certain guiding significance in the application of laparoscopic surgery in the future,the application of warm and humidified CO₂-induced pneumoperitoneum is worthy of further promotion.However,the clinical trial sample size is small,and has not yet been long-term followed up.Large sample RCTs are needed to confirm in terms of postoperative complications,long-term effects.