| Objective: To investigate the safety and feasibility of laparoscopic radical gastrectomy for distal gastric cancer without nasogastric tube placement or abdominal drains placement by comparing the clinical efficacy of “conventional” laparoscopic radical distal gastrectomy and “tubeless” laparoscopic radical distal gastrectomy.Methods: A retrospective analysis of clinical data was made for 203 patients who underwent laparoscopic radical gastrectomy for distal gastric cancer in Department of Gastrointestinal Surgery,the First Affiliated Hospital of Wannan Medical College from September 2017 to December 2019.To perceive the significance of drainage,clinical data of 90 patients(observation group)were collected by recording the characteristics and drainage volume of nasogastric tube and abdominal drainage tube in previous study.Four kinds of tubes(nasogastric tube,nose-jejunum nutrition tube,abdominal drainage tube and urinary catheter)were routinely placed in observation group during the surgery.In the later study,the clinical data of 113 patients were analyzed,including 40 patients with conventional tube placement(conventional therapy group,CT group)and73 patients with unconventional tube placement(tubeless therapy group,TT group).Of the 73 patients in tubeless therapy group,35 were not inserted with nasogastric tube(no nasogastric tube group,no-NT group)and 38 were not inserted with abdominal drainage tube(no abdominal drainage group,no-AD group).Preoperative clinical baseline information,operation indicators,postoperative recovery,postoperative complications,postoperative pathological results,laboratory examinations,andeconomic indicators were compared among the CT group and the two subgroups of TT group.Results: In the observation group,the drainage volume of nasogastric tubes of 90 patients show a decreasing trend within 3 days after the operation and the overall characteristics gradually change from reddish ooze blood to dark green digestive juices.Within 7 days after the operation,the drainage volume of abdominal drainage tubes show a decreasing trend,and the overall characteristics gradually change from reddish ooze blood to yellowish ascites.Comparing the clinical data of CT group and TT group,there are no statistically significant differences among the CT group and the two subgroups of TT group in preoperative clinical baseline information,operation indicators,postoperative pathological results and laboratory examinations(P>0.05).In terms of postoperative recovery,there are no statistically significant differences between CT group and the no-NT group(P>0.05).However,no-AD group is significantly better than CT group in postoperative VAS pain score,postoperative analgesic dosage administration,the leaving bed time and postoperative hospital stays,with statistically differences(P<0.05).In terms of postoperative complications,there are no significant differences between CT group and no-AD group(P>0.05).However,the number of patients with pharyngalgia in no-NT group is significantly less than that in CT group,with a statistically difference(P<0.05).In terms of postoperative economic indicators,there are no significant differences between CT group and no-NT group(P>0.05).However,the hospitalization cost and medicine proportion in no-AD group are significantly less than those in CT group,with statistically significant differences(P<0.05).Conclusion: "Tubeless" laparoscopic radical gastrectomy for distal gastric cancer is a safe,feasible ERAS treatment plan.The nasogastric tube or the abdominal drainage tube should be used selectively according to intraoperative conditions.More prospective randomized controlled trials are needed to confirm this. |
