| ObjectiveTo observe the recovery indices of gastrointestinal function after laparoscopic surgery for colorectal cancer patients,and to provide reference for formulating the evaluation criteria of gastrointestinal motility after perioperative operation for colorectal cancer patients,and to provide evaluation basis for guiding clinical treatment and effectiveness evaluation.MethodsOn the basis of existing conditions and previous studies,selected patients who met the inclusion criteria for laparoscopic radical resection of colorectal cancer in Anorectal Department of Guangdong Hospital of Traditional Chinese Medicine.Through prospective observation and study,the patients after laparoscopic radical resection of colorectal cancer were observed and recorded:(1)The recovery of gastrointestinal function after laparoscopic radical resection:including the recovery and intensity of bowel sounds,the time of first exhaust after operation,and the first Defecation time;full-flow diet,half-flow diet,general eating time;fever,abdominal distension and pain,nausea and vomit i ng,appetite and other gastrointestinal symptoms.Every day after operation,the clinical indexes of gastrointestinal function were observed and filled in the evaluation form of gastrointestinal function;(2)gastrointestinal motility indicators:electrogastrogram detection indicators before and on the 1st to 7th day after operation;(3)laboratory indicators:white blood cells and C-reactive protein indicators before and on the 1st,3rd and 7th day after operation;hemoglobin and albumin indicators before operation,3rd and 7th day after operation;albumin and blood before operation,3rd and 7th day after operation The serum cortisol was measured on the 3rd and 7th day after operation.ResultsA total of 32 patients with colorectal cancer were enrolled in this study.Eight patients were excluded(1 received neoadjuvant chemotherapy,1 received intraoperative bleeding>400 ml,3 received prophylactic ileostomy,1 had mental disorders,2 had combined organectomy).Twenty-four patients with colorectal cancer completed the whole prospective study,14 males(58.3%)and 10 females(41.7%).Two cases of ascending colon cancer,three cases of descending colon cancer,11 cases of sigmoid colon cancer and 8 cases of rectal cancer underwent laparoscopic radical resection of colorectal cancer.The age was 58.92±7.47,the operation time was 232.46±47.31 min,the amount of bleeding was 94.58±43.84 ml,the first exhaust time was 53.83±17.43 h,the first defecation time was 99.75±29.86 h,the total flow diet time was 5.13±1.33 d and the half-flow diet time was 9.33±4.62 D.Symptoms and signs score:3 days after operation and 7 days after operation,compared with 1 day after operation,there were significant statistical differences in patients' recovery(good recovery,normal recovery,poor recovery).The number of patients with good recovery increased from 0(0.0%)on 1 day after operation to 6(25.0%)on 3 days after operation,and reached 14(58.3%)on 7 days after operation.More than half of the patients recovered well.Among the patients with poor recovery,the number of patients with poor recovery dropped from 23 on the first day to 3 on the third day,and the number of patients with poor recovery dropped to 0 on the seventh day after operation.The leucocyte levels of preoperative and postoperative 1,3 and 7 days were 7.15 ±1.99,12.08±2.39,9.79±3.14 and 8.49±2.64,respectively.Compared with preoperative and postoperative 1 and 3 days,the leucocyte levels were P=0.000(P<0.05).There was a significant difference between preoperative and postoperative 7 days,P=0.134(P>0.05).The median CRP was 1.73,40.75,61.38 and 19.00 before operation,1,3 and 7 days after operation,1 and 7 days after operation,3 and 7 days after operation,3 and 7 days after operation,respectively.The difference was statistically significant(P<0.05).The serum cortisol levels at 3 and 7 days after operation were 454.88±269.02 and 547.33±167.12,respectively.There was no significant difference between the three and 7 days after operation(P=0.154)(P>0.05).Nutritional indicators:The median albumin levels were 45.8,37.7 and 41.4 before operation and 3 and 7 days after operation,respectively.Compared with 3 and 7 days after operation,all P<0.05,the difference was statistically significant.The albumin levels before 3 and 7 days after operation were 123.53±36.42,192.45±64.19,P=0·000(P<0.05).The serum transferrin levels at 3 and 7 days after operation were 1.66±0.30 and 1.97±0.39 respectively,P=0.000(P<0.05),with statistical significance.The results of electrogastrogram analysis showed that there was no significant difference in the percentage of normal slow wave before and after meal in fundus,body,distal antrum and pylorus(P>0.05),but there was significant difference in the percentage of normal slow wave before and after meal on the fifth day after operation in proximal antrum.There was no significant difference in the ratio of main power in fundus,body,distal antrum and proximal antrum before and after operation.There was a significant difference in Pyloric area power ratio between 5 days after operation and 1,2,4 days after operation(P<0.05),indicating that there was a significant difference between 1,2,4 days after operation and 5 days after operation,but there was no significant difference between the other days,indicating that the Pyloric area power ratio showed a gradual recovery on the 5th day after operation.ConclusionAfter laparoscopic surgery for colorectal cancer,under the premise of general treatment and no significant intervention of gastrointestinal motility factors:1.Symptoms and signs indicators suggest that the recovery is better on the 3rd day and 7th day after operation.2.Postoperative inflammatory stress indicators suggest that the level of nutritional indicators is gradually recovered.3.The electrogastrogram indicated that the general gastric motility was slow,and the gastric fundus and pylorus suggested that the 3rd and 5th day after operation might be the time point for the recovery of gastrointestinal function. |
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