| Objective: Fast track surgery(FTS)is characterized by the comprehensive strategies based on evidence-based optimized perioperative approaches,aiming to reduce physiological or psychological stress responses caused by surgery and potential occurrences of postoperative complications,and to facilitate postoperative recovery in patients.In this study,we compared the difference of operative time,estimated blood loss,bowel function revival time,hospital stay and the complication rate in children with Hirschsprung's disease(HD),who underwent either FTS perioperative care or traditional perioperative care respectively,through which the potential clinical application value of FTS was explored and evaluated.Furthermore,immure and protein mechanism indexes in peripheral blood was collected and detected in pre-and post-laparoscopic surgery induced by FTS to explore the effects of minimally invasive surgery on stress and potential injury in HD.Methods:1 In two different periods(Period A: between January 2001 and December 2003;Period B: between January 2016 to December 2016),a total of 63 children with HD underwent surgery in our department and their clinical data were collected for analysis retrospectively.Among them,32 cases(Control group)who underwent conventional open surgery in period A and were treated with traditional perioperative care,31 cases(FTS group)underwent laparoscopic surgery in period B and were treated with FTS perioperative care.The difference of operative time,estimated blood loss,drainage time,bowel function revival time,and hospital stay,as well as complication rate between both groups was compared.2 The stress response of FTS was further investigated through comparison.In this regard,measurement of cellular immune parameters inperipheral venous blood harvested was engaged in pre-and at day 1 and day 3post-operatively,including CD3+ percent,CD3+CD4+ percent,CD3+CD8+percent,CD4/CD8 rate,CD3-CD19+ percent and CD3-CD16+CD56+ percent.In addition,examination of human immune parameters from the same blood samples was conducted,involving IgG,IgM,IgA,complement C3 and C4.Meanwhile,we examined C-reactive protein and prealbumin levels in the some blood samples.SPSS 21.0 were utilized for data statistic and analysis the changes of immunity and metabolism norm in perioperative period.Results: After analysis and comparison,data in this study were listed as follows:1 General information in both groups: All HD patients in both groups were completed successfully referring to their perioperative care respectively and no death was found in them.(1)Operative time(OT): The average OT was 145.48±90.07 min in FTS group was short in comparison to control group(187.03±53.14 min),and significantly statistic difference was presented(P<0.05);(2)Estimated blood loss(BL): The average BL was 10.16 ± 6.87 ml in FTS group was less than that in control group(40.72±23.58 ml)and significant difference was noted in both group(P<0.05);(3)Drainage time:(1)Nasogastric drainage: Average 37.09±11.89 hours in FTS group was needed to remove gastric tube,which was significantly less than that in control group(77.91±20.57 hours)(P<0.05),(2)Urinary drainage: The average 17.55±3.83 hours in FTS group was needed before removing of urethral catheter,which was short compared with control group(78.88 ±19.91 hours)(P<0.05),(3)Anal drainage tube: The postoperative anal drainage tube was retained 1-3 days(average 2.06±1.09 days)in FTS group,while in control group,traditional circular duckbill pliers as stapler and potential drainage stent would automatically fall off from the new rectum in postoperative 4-13 days(average 7.56±3.05 days),and significant difference could be seen in two groups(P<0.05);(4)Postoperative bowel peristalsis revival time: The average time in FTS group was 36.55± 13.89 hours and43.75 ±16.98 hours in control group,no difference could be seen betweenthem(P>0.05);(5)Preoperative bowel irrigation preparation time: The average time in FTS group was 5.09± 2.10 days and 15.02 ±4.99 days in control group,statistic difference between them could be noted(P<0.01);(6)Post-operative hospital stay: The average post-operative hospital stay in FTS group was 5.65±1.08 days and 15.63±4.32 days in control group,statistic difference between them could be noted(P<0.01);(7)Hospital stay: The average hospital stay in FTS group was 11.74±1.91 days and 31.84 ±6.97 days in control group,statistic difference between them could be noted(P<0.01);(8)Complications:Only 1 case of postoperative intra-abdominal residual infection(3.2%)was found in FTS group,while in control group,total 7 cases of complications was found(21.9%),including 1 case of anastomotic stricture,1 case of intestinal obstruction,and 2 cases of wound dehiscence,as well 3cases of abdominal incision infection,there has a statistically significant difference between two groups(P<0.05).2 Immune response and protein metabolism data in both groups:(1)The changes of lymphocyte subsets:(1)CD3+ percent: CD3+ percent at time point of 24 hours post-operationally was decreased compared with the pre-operation(P<0.05),it increased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P<0.05),and almost reached to pre-operational level(P=0.273);(2)CD3+CD4+ percent:CD3+CD4+ percent at time point of 24 hours post-operationally was lower compared with the pre-operation(P<0.05),it increased at time point of 72 hours post-operationally compared with time point of 24 hours post-operationally(P<0.05),and almost reached to pre-operational level(P=0.899);(3)CD3+CD8+ percent: There was no difference among the time points at 24 hours and 72 hours in pre-and post-operationally,and no statistically difference was seen(P=0.270);(4)CD4/CD8 rate: There was no difference among the time points in pre-and at 24 hours and 72 hours post-operationally(P>0.05),and no statistically difference was seen(P=0.193);(5)CD3-CD19+ percent: CD3-CD19+ percent at time point of 24 hours post-operationally was increased compared with that in time point of 24 hours pre-operationally(P<0.05),it did not present significant difference compared with that in time point of 24 hours post-operationally(P=0.151),but it increased significantly in contrast to that in pre-operational level(P<0.05);(6)CD3-CD16+CD56+ percent: CD3-CD16+CD56+ percent at time point of 24 hours post-operationally did not presented differences compared with that in time point of 24 hours pre-operationally(P=0.349),and it decreased at time point of 72 hours post-operationally in contrast to time that in point of 24 hours pre-operationally(P<0.05).(2)The human immune parameters:(1)Ig G: There was no difference among the time points in preand at 24 hours and 72 hours post-operationally,and no statistically difference was seen(P=0.209);(2)IgM: There was no difference among the time points in pre-and at 24 hours and 72 hours post-operationally,and no statistically difference was found(P=0.744);(3)IgA: There was no difference among the time points in pre-and at 24 hours and 72 hours post-operationally,and no statistically difference was noted(P=0.945);(4)Complement C3:There was no difference among the time points in pre-and at 24 hours and 72 hours post-operationally,and no statistically difference was noted(P=0.113);(5)Complement C4: There was no difference among the time points in preand at 24 hours and 72 hours post-operationally,and no statistically difference was found(P=0.380);(3)CRP: CRP at time point of 24 hours post-operationally was increased compared with that in pre-operation(P<0.01),it decreased at time point of 72 hours post-operationally compared with the time point of 24 hours post-operationally(P<0.05),and still higher than that in pre-operational level(P<0.01);(4)PA: there was no difference among the time points in pre-and at 24 hours and 72 hours post-operationally,and no statistically difference was noted(P=0.242).Conclusions:1 Utilization of FTS in perioperative period of Hirschsprung's disease can significantly reduce postoperative hospital stay and the drainage time,decrease occurrence of postoperative complications.Laparoscopic minimally invasive surgery can contribute to reduce the operative time and blood loss,accelerate recovery,which presents a good prospective in clinical application.2 The laparoscopic minimally invasive surgery combined with FTS can effectively reduce the perioperative stress response and reduce impact on immunity function and protein metabolism,through which postoperative recovery in HD patients is accelerated. |
PDF Full Text Request