Effects Of Enhanced Recovery After Surgery (ERAS) On Serum IL-6, IL-10, TNF-? And Cortisol Concentrations In Patients With Gallstones Complicated With Choledocholithiasis

Objective: To study the changes of serum IL-6,IL-10,TNF-? and COR levels in patients with gallbladder stones complicated with common bile duct stones before and after operation,and to apply the Enhanced Recovery After Surgery(ERAS)to their level,and to explore the accelerated rehabilitation surgical strategy in gallstone consolidation.Perioperative feasibility and clinical value of patients with common bile duct stones.Methods:Thirty patients undergoing laparoscopic cholecystectomy+ ccommon bile duct exploration and decompression of common bile duct or T tube were selected from December 2,2017 to December 2018 in the Department of General Surgery,Baotou Central Hospital.Patients with drainage were enrolled in the study,and patients were randomized into the ERAS group(15 patients,using accelerated rehabilitation surgery perioperative management strategy)and the control group(15 patients,using conventional surgical perioperative management strategies)according to the inclusion criteria and exclusion criteria.Serum IL-6,IL-10,and TNF-? concentrations were measured 1 day before surgery and 1 day,3 days,and7 days after surgery using ELISA(enzyme-linked immunosorbent assay).The concentration of COR was detected by chemiluminescence.The changes of serum IL-6,IL-10,TNF-? and COR concentrations before and after operation were observed.The postoperative patients' rehabilitation status,complications,postoperative hospital stay and cost were observed.Results:1.There was no significant difference in preoperative IL-6 levels between the two groups(P>0.05).There was a statistically significant difference in IL-6levels between the 1st and 3rd day after surgery(P<0.05).There was no significant difference in IL-6 levels on the 7th day after surgery(P>0.05).There were significant differences in IL-6 levels between the 1st day before surgery and 1st and 3rd day after operation in the ERAS group(P<0.05).There was no significant difference between the IL-6 levels and the 7 days after operation(P>0.05).).There was significant difference in IL-6 levels between the control group and the 1st and3 rd day after operation(P<0.05).There was no significant difference between the control group and the 7-day postoperative IL-6 level(P>0.05).2.There was no significant difference in preoperative IL-10 levels between the two groups(P>0.05).There was a statistically significant difference in IL-10 levels between the 1st and 3rd day after surgery(P<0.05).There was no significant difference in IL-10 levels between the 7th day after surgery(P>0.05).There was no significant difference in IL-10 levels between the 1st day before surgery and 1st and 7th day after operation in the ERAS group(P>0.05).There was significant difference between the IL-10 levels and the 3 days postoperatively(P<0.05).).There was significant difference in IL-10 levels between the control group and the1 st and 3rd day after operation(P<0.05).There was no significant difference between the control group and the 7-day IL-10 level(P>0.05).3.There was no significant difference in the preoperative TNF-? levels between the two groups(P>0.05).The difference of TNF-? level on the first day after operation was statistically significant(P<0.05).There was no significant difference in TNF-?levels between the 3rd and 7th day after surgery(P>0.05).There were significant differences in TNF-? levels between the 1st day before surgery and 1 day after operation in the ERAS group(P<0.05).There was no significant difference between the TNF-? levels and the 3 and 7 days after operation(P>0.05).).There was significant difference in the level of TNF-? between the control group and the day after operation(P<0.05).There was no significant difference between the control group and the TNF-? level at 3 and 7 days after operation(P>0.05).4.There was no significant difference in preoperative COR levels between the two groups(P>0.05).There was a statistically significant difference in COR levels on the first postoperative day(P<0.05).There was no significant difference in COR levels between 3 and 7 days after operation(P>0.05).There were significant differences in COR levels between the 1st day before surgery and 1st and 3rd day after operation in the ERAS group(P<0.05).There was no significant difference between the two groups(P>0.05).There was significant difference in COR level between the control group and the 1-day postoperative day(P<0.05).There was no significant difference between the two groups(P>0.05).5.The first exhaust time,defecation time,total fluid volume,hospitalization cost and postoperative hospital stay in the ERAS group were significantly shorter than those in the control group(P<0.05),and the incidence of postoperative complications was not statistically significant(P>0.05).Conclusion:1.Serum proinflammatory cytokines IL-6 and TNF-? were elevated in patients with gallstones complicated with common bile duct stones.COR increased and anti-inflammatory factor IL-10 decreased.2.ERAS strategy can reduce the postoperative inflammatory stress state of patients with gallstones complicated with common bile duct stones,promote postoperative recovery,shorten hospitalization time,reduce hospitalization costs,and increase the incidence of postoperative complications,it is worth promoting in clinical use.