| Objective:To investigate the effect of accelerated recovery after surgery(ERAS)in laparoscopic radical resection of gastric cancer and its effect on postoperative insulin resistance,and to explore the best treatment plan for laparoscopic combined accelerated rehabilitation surgery during the perioperative period.Methods:1.Retrospectively selected 40 patients with gastrointestinal surgery from Tongling People's Hospital from May 2016 to May 2017.Laparoscopic radical resection of gastric cancer was performed in 40 patients as the ERAS group.In the same period,the perioperative period was treated with traditional methods for laparoscopy.Forty patients with gastric cancer were used as the control group.Analysis of surgical-related indicators(operation time,number of postoperative lymph node dissections,intraoperative bleeding volume)in the ERAS group and the traditional group;serum albumin,C-reactive protein,IL-6 and PCT levels,and the first day before surgery,the first day after surgery,the third day,and postoperative recovery indicators(time to recover bowel sounds,first exhaust Differences in recovery time,first oral diet time,nasal bowel extubation time,parenteral nutrition use time,length of hospital stay,hospitalization cost,postoperative pain VAS score,postoperative weight to preoperative weight ratio,postoperative complications).2.Prospective selection of 80 patients who underwent laparoscopic radical gastrectomy for gastric cancer from May 2017 to May 2019 in Tongling People's Hospital were randomly divided into the ERAS group and the observation group.Compare fasting blood glucose and fasting insulin levels on the 1st day before surgery,1st day,3rd day,and 5th day at 7:00 am.Results:There were no significant differences in gender,age,BMI,surgical methods,anastomosis methods,tumor size,and postoperative TMN between the two groups(P> 0.05).Intraoperative index control group,operation time,intraoperative blood loss,and number of lymph node dissection were compared between the two groups: 240.56 ± 28.04 min,71.75 ±38.16 ml,23 ± 6.2,ERAS were 237.25 ± 48.70 min,62.25 ± 35.19 ml,25 ± 7.4,no statistical significance between the two(P> 0.05);the volume of fluid replacement and the length of the incision in the control group were 2440.00 ± 182.29 ml and 9.7 ± 2.30 cm,and the ERAS group were 2288.75 ± 397.18 ml,7.4 ± 1.65 cm,the difference is statistically significant(P<0.05).The postoperative ventilation time in the two groups was compared with 54.91 ±24.94 h in the ERAS group,and 65.79 ± 22.04 h in the control group;postoperative defecation time in the ERAS group was 63.37 ± 26.66 h,and the control group was 74.18 ±20.31h;the first time to get out of bed was 18.58 in the ERAS group.± 3.30 h,control group25.30 ± 4.38h;enteral nutrition time,first oral feeding time,postoperative parenteral nutrition use time,nasal bowel extraction time,postoperative hospitalization time,and total hospitalization cost in the ERAS group It was 19.87 ± 8.45 h,22.41 ± 11.27 h,4.60 ± 2.00 d,8.44 ± 2.87 d,9.23 ± 2.36 d,5.40 ± 0.65 million,and the control group was 41.62 ± 7.04 h,87.55 ± 15.04 h,8.12 ± 2.47 d,9.81 ± 2.66 d,10.64 ± 2.10 d,5.86 ± 0.76 million.Compared with the control group,the ERAS group had shorter time and lower hospitalization costs,both of which were statistically significant(P <0.05).Compared with the two groups,the pain VAS score on the 5th day after surgery was lower in the ERAS group than in the control group on the first 3 days after surgery,and the difference was statistically significant(P <0.05).There was no significant difference in scores on the 4th and 5th days(P> 0.05).Compared with the control group,there was no significant difference in ALB levels in the ERAS group on the first day before surgery,the first day after surgery,and the third day.On the seventh day after surgery,the ERAS group and the control group were 36.6 ± 2.6g / L,35.6 ± 1.9g / L,there was a statistical difference(P <0.05).There was no statistical difference in BWR between the two groups on the 1st,3rd,and 30 th days after the operation(P> 0.05),and the ERAS group was higher than the control group only on the 7th day after the operation(P <0.05).The inflammation stress indicators CPR,IL-6,and PCT were compared between the two groups,and the levels of the two groups were higher than before surgery on the 1st,3rd,and 7th days after surgery,and the differences were statistically significant(P <0.01);Compared with the ERAS group,the level was lower than the control group,and the difference was statistically significant(P <0.05).Comparison of postoperative complications between the two groups of patients.The incidence of ClavienDindo grade I in the ERAS group was 17.5% lower than the control group's 40%.The difference was statistically significant(P <0.05).There was no statistical difference between the groups(P> 0.05).There was no significant difference in insulin resistance index between the two groups on the first day before surgery(P> 0.05),and the ERAS level was lower than that of the control group on the first,third,and fifth days after surgery(P <0.01)Conclusion: The ERAS concept is safe and effective when applied to laparoscopic radical gastrectomy.It can promote the recovery of intestinal function after surgery,shorten the length of hospital stay,reduce stress response,improve nutritional status and reduce hospitalization costs.At the same time,ERAS has certain advantages in reducing insulin resistance after laparoscopic gastric cancer radical surgery... |
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