| Objective:To explore the feasibility,effectiveness and safety of ERAS management model in laparoscopic anterior rectal resection for elderly rectal cancer patients.Method:From October 2016 to May 2018,100 elderly patients diagnosed by gastrointestinal,colorectal and anal surgery in our hospital who met the inclusion criteria and underwent laparoscopic anterior rectal resection were randomly divided into two groups.50 patients who underwent ERAS management mode during perioperative period were included in ERAS group,and 50 patients who underwent traditional management mode during perioperative period were included in routine group.Record and compare the clinical indicators of the two groups: preoperative general information,surgical related indicators,nutritional indicators,immune function indicators,inflammatory indicators,postoperative rehabilitation indicators,postoperative complications.The research data of each clinical index of the two groups were input into SPSS20.0 software for statistical data processing after confirmation.Result:1.General data of two groups: age,sex,combined basic diseases(heart disease,hypertension,diabetes mellitus,chronic obstructive pulmonary disease),histological classification of tumors,TNM stage of tumors,and diameter of tumors had no significant difference(P > 0.05).2.There was no significant difference in operation time,incision length,number of lymph node dissection and intraoperative bleeding between the two groups(P >0.05).3.There was no significant difference in nutritional indicators between the two groups on the first day before operation: albumin,prealbumin and hemoglobin(P >0.05);the nutritional indicators of ERAS group on the first,third and fifth day after operation were higher than those of routine group,and the difference was statisticallysignificant(P < 0.05).4.There was no significant difference in CD4+,CD8+,CD4+/CD8 between the two groups on the first day before operation(P > 0.05).CD4+,CD4+/CD8+ in ERAS group on the first,third and fifth day after operation were higher than those in routine group,and CD8+ was lower than that in routine group(P < 0.05).5.There was no significant difference in CRP concentration,SAA concentration and WBC count between the two groups on the first day before operation(P > 0.05),but the inflammatory indexes in ERAS group on the first,third and fifth day after operation were lower than those in the conventional group(P < 0.05).6.Postoperative rehabilitation indicators in ERAS group: catheter extraction time,first oral feeding time,first ambulation time,first exhaust time and drainage tube extraction time were significantly earlier than those in routine group(P < 0.05).Pain score,hospitalization days and hospitalization expenses were lower than those in routine group(P < 0.05).7.Postoperative complications in ERAS group: nausea and vomiting,abdominal distension,incision infection,anastomotic leakage,pulmonary infection were lower than those in routine group,and the incidence of urinary retention was higher than that in routine group,but the difference was not statistically significant(P > 0.05).The incidence of urinary tract infection in ERAS group was lower than that in routine group(P < 0.05).Conclusion:1.It is feasible,safe and effective to apply ERAS management model in perioperative period of laparoscopic anterior rectal resection for elderly patients,which has high clinical value.2.ERAS management model can reduce the stress response of elderly patients during operation and promote the recovery of nutritional status and immune function after operation.3.ERAS management model can reduce complications,shorten hospitalization time and reduce hospitalization costs,and has broad application prospects.4.Laparoscopic rectal cancer resection with double cannula drainage isconducive to reduce the occurrence of anastomotic leakage after surgery,and is conducive to non-surgical treatment after anastomotic leakage,avoiding reoperative intervention. |
PDF Full Text Request